Provider Demographics
NPI:1912274564
Name:KATCHATAG, LAVERNA ANN (CHA-IV-C)
Entity Type:Individual
Prefix:MRS
First Name:LAVERNA
Middle Name:ANN
Last Name:KATCHATAG
Suffix:
Gender:F
Credentials:CHA-IV-C
Other - Prefix:
Other - First Name:LAVERN
Other - Middle Name:ANN
Other - Last Name:KRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:907-842-5201
Practice Address - Street 1:189 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:TOGIAK
Practice Address - State:AK
Practice Address - Zip Code:99678
Practice Address - Country:US
Practice Address - Phone:907-493-5511
Practice Address - Fax:907-493-5511
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK99-920-IV172V00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK99--920-IVOtherCHA-IV-C