Provider Demographics
NPI:1407379472
Name:TUNGUING, SHAWNA MAE (CHA)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MAE
Last Name:TUNGUING
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 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KOLIGANEK
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-596-3431
Practice Address - Fax:907-596-3491
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17-1427-II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker