Provider Demographics
NPI:1316419096
Name:LESTENKOF-MANDREGAN, CARA PAIGE ALEXANDRA (CHA-1)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:PAIGE ALEXANDRA
Last Name:LESTENKOF-MANDREGAN
Suffix:
Gender:F
Credentials:CHA-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 POLOVINA TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL ISLAND
Mailing Address - State:AK
Mailing Address - Zip Code:99660
Mailing Address - Country:US
Mailing Address - Phone:907-546-8300
Mailing Address - Fax:
Practice Address - Street 1:1000 POLOVINA TURNPIKE
Practice Address - Street 2:
Practice Address - City:ST. PAUL ISLAND
Practice Address - State:AK
Practice Address - Zip Code:99660
Practice Address - Country:US
Practice Address - Phone:907-546-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker