Basic Information
| Provider Information | |||||||||
| NPI: | 1326315813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAZURUK | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | DARREN | ||||||||
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| Credential: | CHA III | ||||||||
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| Mailing Information | |||||||||
| Address1: | #3 ADAMS LANDING-OLD | ||||||||
| Address2: | BOX 180 | ||||||||
| City: | SELAWIK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074842199 | ||||||||
| FaxNumber: | 9074842119 | ||||||||
| Practice Location | |||||||||
| Address1: | #3 ADAMS LANDING-OLD | ||||||||
| Address2: | |||||||||
| City: | SELAWIK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074842199 | ||||||||
| FaxNumber: | 9074842119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2011 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 10-1062-II | AK | Y | Other Service Providers | Community Health Worker |
No ID Information.