Provider Demographics
NPI:1629345319
Name:SAVETILIK, EDNA (CHP)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:SAVETILIK
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MAIN STREET
Mailing Address - Street 2:BOX 09
Mailing Address - City:SHAKTOOLIK
Mailing Address - State:AK
Mailing Address - Zip Code:99771-0009
Mailing Address - Country:US
Mailing Address - Phone:907-955-2442
Mailing Address - Fax:907-955-2506
Practice Address - Street 1:1ST MAIN STREET
Practice Address - Street 2:BOX 09
Practice Address - City:SHAKTOOLIK
Practice Address - State:AK
Practice Address - Zip Code:99771-0009
Practice Address - Country:US
Practice Address - Phone:907-955-2442
Practice Address - Fax:907-955-2506
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK99-237-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker