Provider Demographics
NPI:1710616719
Name:RAYMOND, TINA MARIE (CHA-T)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:CHA-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-443-3311
Mailing Address - Fax:907-443-3471
Practice Address - Street 1:50 SCHOOL BLVD
Practice Address - Street 2:
Practice Address - City:STEBBINS
Practice Address - State:AK
Practice Address - Zip Code:99672-9967
Practice Address - Country:US
Practice Address - Phone:907-934-3311
Practice Address - Fax:907-934-3312
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CHA-TOtherCHA-T