Provider Demographics
NPI:1942714654
Name:SHANGIN, REBECCA A
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:SHANGIN
Suffix:
Gender:F
Credentials:
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 130
Mailing Address - Street 2:CHIGNIK LAKE CLINIC
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:CHIGNIK LAKE CLINIC
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0130
Practice Address - Country:US
Practice Address - Phone:907-842-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17-1425-LL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker