Provider Demographics
NPI:1124282181
Name:KAMEROFF, AGNES (CHP)
Entity type:Individual
Prefix:MS
First Name:AGNES
Middle Name:
Last Name:KAMEROFF
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16215 E YE OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7722
Mailing Address - Country:US
Mailing Address - Phone:907-310-8536
Mailing Address - Fax:
Practice Address - Street 1:100 SLOCUM DRIVE
Practice Address - Street 2:
Practice Address - City:KING COVE
Practice Address - State:AK
Practice Address - Zip Code:99612-0009
Practice Address - Country:US
Practice Address - Phone:907-497-2311
Practice Address - Fax:907-497-2310
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker