Basic Information
| Provider Information | |||||||||
| NPI: | 1225454069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOBELUK | ||||||||
| FirstName: | ELIZA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50 | ||||||||
| Address2: | |||||||||
| City: | NUNAPITCHUK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996410050 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 JOHNSON SLOOP | ||||||||
| Address2: | |||||||||
| City: | NUNAPITCHUK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996410050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075275339 | ||||||||
| FaxNumber: | 9075275872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.