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PEMERINTAH KABUPATEN KARANGASEM

DINAS KESEHATAN
UPTD KESEHATAN / PUSKESMAS SELAT
Jalan Raya Selat, Kode Pos : 80862
Email : selat.pusk@gmail.com, No. Hp : 082341440012

BIODATA

NAMA : .............................................................................................................
NIP : ............................................................................................................

PANGKAT : ............................................................................................................

TEMPAT / TANGGAL LAHIR : ............................................................................................................

PENDIDIKAN TERAKHIR : ............................................................................................................

JABATAN (Fungsional / Struktural) : ............................................................................................................

TUGAS TAMBAHAN (Program) : ............................................................................................................

Yang Membuat,

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NIP.