Jackie Eningowuk, CHA-T

Individual provider Active NPI Community Health Worker · Shishmaref, AK

NPI 1760848261 · NPPES record last updated Jan 13, 2016

Key facts

NPI
1760848261
Entity type
Individual (NPI type 1)
Primary specialty
Community Health Worker 172V00000X
Practice address
123 Oceanview
Shishmaref, AK 99772
Phone
(907) 649-3311
Fax
(907) 649-2083
NPI assigned
Jan 13, 2016
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X AK Yes

Addresses

Primary practice location

123 Oceanview
Shishmaref, AK 99772

Mailing address

123 Oceanview
Shishmaref, AK 99772
Phone (907) 649-3311

Other identifiers

IdentifierTypeStateIssuer
CHA-TOtherAKCHA-T

Other providers in Shishmaref, AK

All providers in Shishmaref, AK · Community Health Worker in Alaska

Sources for this page

Verify at the official NPI Registry.