Provider Demographics
NPI:1861889941
Name:ANNOGIYUK, JORDAN (CHA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:ANNOGIYUK
Suffix:
Gender:M
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:AIRPORT ROAD 151
Mailing Address - Street 2:SAVOONGA CLINIC
Mailing Address - City:SAVOONGA
Mailing Address - State:AK
Mailing Address - Zip Code:99769
Mailing Address - Country:US
Mailing Address - Phone:907-984-6513
Mailing Address - Fax:907-984-6068
Practice Address - Street 1:AIRPORT ROAD 151
Practice Address - Street 2:
Practice Address - City:SAVOONGA
Practice Address - State:AK
Practice Address - Zip Code:99769
Practice Address - Country:US
Practice Address - Phone:907-984-6513
Practice Address - Fax:907-984-6068
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA-IIOtherCHA-II