Jill Booshu, CHA IV
Individual provider Active NPI Community Health Worker · Gambell, AK
NPI 1174890867 · NPPES record last updated Nov 23, 2011
Key facts
- NPI
- 1174890867
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- License
- 03-602-IV (AK)
- Practice address
- 190 Clinic Road
Box 190
Gambell, AK 99742-0190 - Phone
- (907) 985-5015
- Fax
- (907) 985-5085
- NPI assigned
- Nov 23, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03-602-IV | AK | MD | Community Health Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 03-602-IV | AK | Yes |
Addresses
Primary practice location
190 Clinic Road
Box 190
Gambell, AK 99742-0190
Mailing address
190 Clinic Road
Box 190
Gambell, AK 99742-0190
Phone (907) 985-5015
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CHA-IV | Other | AK | 03-602-IV |
Other providers in Gambell, AK
- Ashton Matthew Apangalook-Aningayou
- Kristina Apassingok
- Susan A Bryer
- Carrina F Campbell
- Sophie M Kaningok
- Barton D Koonooka
- Channa Lisa Koozaata
All providers in Gambell, AK · Community Health Worker in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.