Provider Demographics
NPI:1194063362
Name:NASH, MARITA PAULINE
Entity type:Individual
Prefix:
First Name:MARITA
Middle Name:PAULINE
Last Name:NASH
Suffix:
Gender:F
Credentials:
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 246
Mailing Address - Street 2:
Mailing Address - City:CHEVAK
Mailing Address - State:AK
Mailing Address - Zip Code:99563-0246
Mailing Address - Country:US
Mailing Address - Phone:907-858-7267
Mailing Address - Fax:
Practice Address - Street 1:829 CHIEF EDDIE HOFFMAN
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0150Medicaid