Provider Demographics
NPI:1104449636
Name:PLEASANT, DONALD MAX (CHA-T)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MAX
Last Name:PLEASANT
Suffix:
Gender:M
Credentials:CHA-T
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 966
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-624-3535
Mailing Address - Fax:907-624-3692
Practice Address - Street 1:AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:UNALAKLEET
Practice Address - State:AK
Practice Address - Zip Code:99684-0000
Practice Address - Country:US
Practice Address - Phone:907-624-3535
Practice Address - Fax:907-624-3692
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA-TOtherCHA-T