Provider Demographics
NPI:1912346040
Name:KATCHATAG, CHARLENE RACHEL (HEALTH AIDE)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:RACHEL
Last Name:KATCHATAG
Suffix:
Gender:F
Credentials:HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:09 RIVER VIEW
Mailing Address - Street 2:
Mailing Address - City:SHAKTOOLIK
Mailing Address - State:AK
Mailing Address - Zip Code:99771
Mailing Address - Country:US
Mailing Address - Phone:907-955-3311
Mailing Address - Fax:907-995-2342
Practice Address - Street 1:09 RIVER VIEW
Practice Address - Street 2:
Practice Address - City:SHAKTOOLIK
Practice Address - State:AK
Practice Address - Zip Code:99771
Practice Address - Country:US
Practice Address - Phone:907-955-3311
Practice Address - Fax:907-995-2342
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13-1229-II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK13-1229-IIOtherCHA II