1821375510 NPI number — MICHELE MARIE GALUSZKA CHAP

Table of content: MICHELE MARIE GALUSZKA CHAP (NPI 1821375510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821375510 NPI number — MICHELE MARIE GALUSZKA CHAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALUSZKA
Provider First Name:
MICHELE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CHAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIDAY
Provider Other First Name:
MICHELE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CHAP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821375510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 TONGASS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SITKA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99835-9416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-966-2411
Provider Business Mailing Address Fax Number:
907-966-8656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 TONGASS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SITKA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99835-9416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-966-2411
Provider Business Practice Location Address Fax Number:
907-966-8656
Provider Enumeration Date:
11/08/2011

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)

  • Identifier: 1576374 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".