Provider Demographics
NPI:1760846505
Name:TIKIUN, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:TIKIUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6044
Mailing Address - Street 2:
Mailing Address - City:NAPASKIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99559-6044
Mailing Address - Country:US
Mailing Address - Phone:907-737-7329
Mailing Address - Fax:907-737-7435
Practice Address - Street 1:ELENA ALEXIE MEMORIAL HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:NAPASKIAK
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-737-7329
Practice Address - Fax:907-737-7435
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7415423247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other