Provider Demographics
NPI:1972088078
Name:KUSAYAK, CHANTEL CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:CHRISTINA
Last Name:KUSAYAK
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 1:101 ARMY WAY
Mailing Address - Street 2:
Mailing Address - City:TUNTUTULIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99680
Mailing Address - Country:US
Mailing Address - Phone:907-256-2717
Mailing Address - Fax:907-256-2129
Practice Address - Street 1:101 ARMY WAY
Practice Address - Street 2:
Practice Address - City:TUNTUTULIAK
Practice Address - State:AK
Practice Address - Zip Code:99680
Practice Address - Country:US
Practice Address - Phone:907-256-2717
Practice Address - Fax:907-256-2129
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker