Provider Demographics
NPI:1245507938
Name:KUZUGUK, STEPHANIE K (CHA IV)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:KUZUGUK
Suffix:
Gender:F
Credentials:CHA IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 133
Mailing Address - Street 2:
Mailing Address - City:SHISHMAREF
Mailing Address - State:AK
Mailing Address - Zip Code:99772-0133
Mailing Address - Country:US
Mailing Address - Phone:907-649-3311
Mailing Address - Fax:907-649-2083
Practice Address - Street 1:133 LAGOON STREET
Practice Address - Street 2:
Practice Address - City:SHISHMAREF
Practice Address - State:AK
Practice Address - Zip Code:99772-0133
Practice Address - Country:US
Practice Address - Phone:907-649-3311
Practice Address - Fax:907-649-2083
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
AK09-1019-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK09-1019-IVOtherCHA IV