Provider Demographics
NPI:1982835658
Name:CHUKWAK, ANECIA (CHP-C)
Entity Type:Individual
Prefix:
First Name:ANECIA
Middle Name:
Last Name:CHUKWAK
Suffix:
Gender:F
Credentials:CHP-C
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 2088
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2088
Mailing Address - Country:US
Mailing Address - Phone:907-224-3490
Mailing Address - Fax:907-224-5870
Practice Address - Street 1:625 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHENEGA BAY
Practice Address - State:AK
Practice Address - Zip Code:99574-8029
Practice Address - Country:US
Practice Address - Phone:907-573-5129
Practice Address - Fax:907-573-5148
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker