Provider Demographics
NPI:1487170072
Name:PITKA, RENE LATISHA (CHA-IV)
Entity type:Individual
Prefix:MS
First Name:RENE
Middle Name:LATISHA
Last Name:PITKA
Suffix:
Gender:F
Credentials:CHA-IV
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:LATISHA
Other - Last Name:EWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHA-IV
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-0508
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:888-959-2389
Practice Address - Street 1:MILE 111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-0508
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:888-959-2389
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker