Provider Demographics
NPI:1891930699
Name:NATIVE VILLAGE OF EKLUTNA
Entity Type:Organization
Organization Name:NATIVE VILLAGE OF EKLUTNA
Other - Org Name:EKLUTNA VILLAGE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:907-688-6031
Mailing Address - Street 1:26339 EKLUTNA VILLAGE RD
Mailing Address - Street 2:P.O. BOX 670666
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5148
Mailing Address - Country:US
Mailing Address - Phone:907-688-6031
Mailing Address - Fax:907-688-6032
Practice Address - Street 1:26339 EKLUTNA VILLAGE RD.
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-0666
Practice Address - Country:US
Practice Address - Phone:907-688-6031
Practice Address - Fax:907-688-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP02962Medicaid
AKCL5246Medicaid
AK152644Medicare PIN
AKP43844Medicare UPIN
AK152649Medicare PIN