Provider Demographics
NPI:1669902680
Name:DAVID, CAROLYN NORA (CHP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:NORA
Last Name:DAVID
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111.5 RICHARDSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-0508
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:
Practice Address - Street 1:111.5 RICHARDSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-0508
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPENDING172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker