MEDICARE: SARA JOHNEE ELMA SEETOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	05-748-P	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05-748-P	OTHER		CHP

General Provider Information

NPI Number	:	1851724058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JOHNEE ELMA SEETOT

Provider Business Mailing Address
First Line	:	WEST CLARENCE STREET
Second Line	:
City	:	BREVIG MISSION
State	:	AK
Zip	:	99785
Country	:	US
Telephone Number	:	907-642-4311
Fax Number	:	907-642-2216

Provider Business Practice Location Address
First Line	:	WEST CLARENCE STREET
Second Line	:
City	:	BREVIG MISSION
State	:	AK
Zip	:	99785
Country	:	US
Telephone Number	:	907-642-4311
Fax Number	:	907-642-2216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/12/2013

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Directions to “ SARA JOHNEE ELMA SEETOT ” Practice Location

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