1740007681 NPI number — ANNE'CECILLA BUZRA TEPSEKOK WILSON CHA-T

Table of content: ANNE'CECILLA BUZRA TEPSEKOK WILSON CHA-T (NPI 1740007681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740007681 NPI number — ANNE'CECILLA BUZRA TEPSEKOK WILSON CHA-T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
ANNE'CECILLA
Provider Middle Name:
BUZRA TEPSEKOK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CHA-T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740007681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOME
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99762-0966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-443-3465
Provider Business Mailing Address Fax Number:
907-443-3471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EAST 2ND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOYUK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99753-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-963-3311
Provider Business Practice Location Address Fax Number:
907-963-3610
Provider Enumeration Date:
09/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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