Provider Demographics
NPI:1497274419
Name:CHURCHILL, PEARL MARGARET (PA-C)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:MARGARET
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 A ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR
Mailing Address - State:AK
Mailing Address - Zip Code:99704-5360
Mailing Address - Country:US
Mailing Address - Phone:907-585-6415
Mailing Address - Fax:907-585-6244
Practice Address - Street 1:200 A ST
Practice Address - Street 2:
Practice Address - City:CLEAR
Practice Address - State:AK
Practice Address - Zip Code:99704-5360
Practice Address - Country:US
Practice Address - Phone:907-585-6415
Practice Address - Fax:907-585-6244
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK139961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program