Provider Demographics
NPI:1043872609
Name:PELOWOOK, JUDITH M (CHA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:PELOWOOK
Suffix:
Gender:F
Credentials:CHA
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 151
Mailing Address - Street 2:
Mailing Address - City:SAVOONGA
Mailing Address - State:AK
Mailing Address - Zip Code:99769-0151
Mailing Address - Country:US
Mailing Address - Phone:907-984-6513
Mailing Address - Fax:907-984-6068
Practice Address - Street 1:151 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:SAVOONGA
Practice Address - State:AK
Practice Address - Zip Code:99769-0151
Practice Address - Country:US
Practice Address - Phone:907-984-6513
Practice Address - Fax:907-984-6068
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHAOther92004188