Provider Demographics
NPI:1558192088
Name:SAGE, JENNIFER (CHA I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:CHA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0043
Mailing Address - Country:US
Mailing Address - Phone:907-442-7161
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 90
Practice Address - Street 2:
Practice Address - City:NOATAK
Practice Address - State:AK
Practice Address - Zip Code:99761-0090
Practice Address - Country:US
Practice Address - Phone:907-485-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker