Provider Demographics
NPI:1841717980
Name:TRUJILLO, ANGELIA CLARK (WHNP)
Entity type:Individual
Prefix:DR
First Name:ANGELIA
Middle Name:CLARK
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10946 IDITAROD CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8239
Mailing Address - Country:US
Mailing Address - Phone:907-223-2180
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 240
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2970
Practice Address - Country:US
Practice Address - Phone:907-406-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125908363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1674581Medicaid