Provider Demographics
NPI:1720578123
Name:MACDOUGALL, SARA A (CHA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:MACDOUGALL
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 31
Mailing Address - Street 2:
Mailing Address - City:CHITINA
Mailing Address - State:AK
Mailing Address - Zip Code:99566-0031
Mailing Address - Country:US
Mailing Address - Phone:907-823-2213
Mailing Address - Fax:907-823-2257
Practice Address - Street 1:MILE 28.5 EDGERTON HWY
Practice Address - Street 2:
Practice Address - City:CHITINA
Practice Address - State:AK
Practice Address - Zip Code:99566
Practice Address - Country:US
Practice Address - Phone:907-823-2213
Practice Address - Fax:907-823-2257
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17-1484-II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker