Provider Demographics
NPI:1912632167
Name:COPPER RIVER NATIVE ASSOCIATION
Entity Type:Organization
Organization Name:COPPER RIVER NATIVE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT FINANCIAL SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIEDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-206-6812
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0383
Mailing Address - Country:US
Mailing Address - Phone:907-602-6812
Mailing Address - Fax:
Practice Address - Street 1:111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573
Practice Address - Country:US
Practice Address - Phone:907-206-6812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty