Provider Demographics
NPI:1295127694
Name:STATE OF ALASKA
Entity type:Organization
Organization Name:STATE OF ALASKA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PUBLIC HEALTH NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TSCHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSN, FNP-C
Authorized Official - Phone:907-334-2283
Mailing Address - Street 1:3601 C ST
Mailing Address - Street 2:SUITE 760
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5923
Mailing Address - Country:US
Mailing Address - Phone:907-334-2283
Mailing Address - Fax:
Practice Address - Street 1:3601 C ST
Practice Address - Street 2:SUITE 760
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5923
Practice Address - Country:US
Practice Address - Phone:907-334-2283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24856261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local