dr. Dini Threes Harjanti 446/2550/174/I-22 07 Januari 2022 Puskesmas Kalasan 1/7/1975 3404124507690005 0000095973063
dr. Izza Hidayati 446/10347/1108/7730/IV-23 12 April 2023 Puskesmas Kalasan 4/12/1976 1505025204760007 0000095970071
dr. Renata Nurul Setyawati 446/8803/1051/7676/I-23 25 Januari 2023 Puskesmas Kalasan 1/25/1992 3404076501920001 0002044140941
dr. Tantiana Budiarti 446/8802/1050/7675/I-23 07 Agustus 2023 Puskesmas Kalasan 8/7/1990 3525024708900004 0001907255968
dr. Elisa Fauziyatul Munawaroh 446/6190/482/VI-19 12 Juni 2019 Puskesmas Kalasan 10/15/1989 3507185510890004 tidak memiliki
dr. Laksamana Olan Es Orlando 446/7992/605/III-23 16 Agustus 2023 Puskesmas Kalasan 3/17/1992 3402161703920001 0001846476652
drg. Sri Herwindra Ratna 446/4633/371/5762/XI-21 22 November 2021 Puskesmas Kalasan 22/11/1960 3404106211600002 0000095964052
drg. Febbia Thartika 446/7465/975/7601/VIII-21 20 Agustus 2021 Puskesmas Kalasan 20/08/1975 3404076008750008 0000205570484
Nur Djannah Alboneh,S.Far.Apt 446/7732/1645/IV-22 24 April 2022 Puskesmas Kalasan 24/04/1978 3471016404780001 0000094331968
Isti setiyaningsih,A.Md 446/7803/7315/V-21 16 Mei 2021 Puskesmas Kalasan 16/5/1983 3310125605830001 0000096268959
Rahma Maratus Sholihah 446/7802/7314/X-20 17 Oktober 2020 Puskesmas Kalasan 5/6/1988 3404014506880008 0000095664903
Impala, AMK 446/2681/4961/VIII-20 15 Agustus 2020 Puskesmas Kalasan 15/8/1966 3404105508660003 0000095963613
Sriyati Sipora, S.Kep 446/7537/7238/VIII-21 05 Agustus 2021 Puskesmas Kalasan 5/8/1969 3404104508690007 0000095964142
Sri Utami, AMK 446/6743/5800/VI-20 14 Juni 2020 Puskesmas Kalasan 14/6/1977 3404075406770007 0000022786165
Priyanto, AMK 446/1081/7810/V-20 23 Mei 2020 Puskesmas Kalasan 23/5/1974 3404112305740001 0000095970295
Niluh Nonik Wamiasih, AMK 446/6780/5801/III-20 29 Maret 2020 Puskesmas Kalasan 29/3/1966 3404106903660001 0000095963769
Bagus Hadi Sulistyo, AMK 446/3624/5183/I-20 08 Januari 2020 Puskesmas Kalasan 8/1/1988 3520020801880001 0000201518469
Dwi Mujiyanto, AMK 300/SPK/VIII/8 dalam proses Puskesmas Kalasan 13/5/1970 3310261305700004 Askes Hilang
Retno Sunaringtyas, AMK 446/5602/3403/II-18 dalam proses Puskesmas Kalasan 27/7/1977 3404116707770007 0000095971239
Dudid Sudaryono, AMK 446/1083/7808/VI-20 10 Juni 2020 Puskesmas Kalasan 10/6/1969 3404101006690001 0000095972848
Surat Ijin Kerja Bidan
5 Bidan
No Surat Ijin Praktik Masa Berlaku alamat Praktik Tanggal Lahir NO NIK NO BPJS Kesehatan keterangan ceklist (di isi oleh petugas
BPJS Kesehatan)
Hastuti, A.Md.Keb 446/4808/1090/VI-20 09 Juni 2020 Puskesmas Kalasan 9/6/1968 3404094901680001 0000095963578
Widi Sih Winarni, A.Md.Keb 446/4810/1089/IV-20 08 April 2020 Puskesmas Kalasan 8/4/1966 3404084804660001 0000095964502
Ys Lukiyani, A.Md.Keb 446/3644/6749/VII-19 27 Juli 2019 Puskesmas Kalasan 27/7/1966 3310076707660001 0000095964625
Nur Nugroho wati, A.Md.Keb 446/3641/6746/VI-20 12 Juni 2020 Puskesmas Kalasan 12/6/1989 3310015206890001 000020596809
Nastiti Handayani, A.Md.Keb 446/3643/6748/XI-20 18 November 2020 Puskesmas Kalasan 18/11/1982 3404105811820002 0000096270131
Supartini, A.Md.Keb 446/3645/6750/VI-20 28 Juni 2020 Puskesmas Kalasan 28/6/1965 3310016806650001 0000095964287
Dwi Winarti, A.Md.Keb 446/3640/6745/I-20 01 Januari 2020 Puskesmas Kalasan 1/1/1969 3310024101690005 0000096614559
Ufi Susilo Wardani, A.Md.Keb 446/6392/8484/XI-21 30 November 2021 Puskesmas Kalasan 30/11/1988 5271067011880002 0000210478105
Windaryanti, A.Md.Keb 446/6866/5849/IV-19 17 April 2019 Puskesmas Kalasan 14/4/1977 3404105704770002 0000095964579
Dyah Resminingsih, A.Md.Keb 446/7835/6124/VIII-20 15 Juli 2020 Puskesmas Kalasan 15/8/1984 3404075508840005 0000197760363
Aan Antasari, A.Md.Keb 446/3642/6747/II-20 15 Februari 2020 Puskesmas Kalasan 15/2/1985 3404105502850002 0000198421457
Retno Dhamayanti, A.Md.Keb 446/6618/8616/III-21 18 Maret 2021 Puskesmas Kalasan 18/3/1974 3404105803740001 0000976128592
Fedelis Galuh Wulan, A.Md.Keb 446/6624/8622/VI-22 10 April 2022 Puskesmas Kalasan 10/4/1986 3402125004860005 0000199235654
Sri Utami, AMKG 446/10353/9795/VII-22 18 Juli 2022 Puskesmas Kalasan 18/7/1969 3404085807690006 0000095957908
Restu Wulan Sari, AMKG 446/5564/1291/IX-21 29 September 2021 Puskesmas Kalasan 9/29/1983 3402156909830001 0000173739295
Sri Sulastri, AMAK 446/6440/8517/I-22 17 Januari 2022 Puskesmas Kalasan 17/1/1973 3404085701730001 0000095964074
Darlistyana Kurniasari, A.Md 446/10033/9680/VIII-22 19 Agustus 2022 Puskesmas Kalasan 19/81988 3520115908880001 0000198767204
Ruky Desha Ratmaning Tiyas, A.Md 446/6718/5775/XII-19 08 Desember 2019 Puskesmas Kalasan 8/12/1989 3404104812890003 0000095160633
Catur haryati Juliana, S.SiT 446/10105/9706/VII-22 21 Juli 2022 Puskesmas Kalasan 21/7/1977 340214610770001 0000095972826
V.linariyati, AMKL 446/10104/9705/I-22 22 Januari 2022 Puskesmas Kalasan 22/1/1968 3471136201680003 0000095957234
Gandung Waluyo, AMG dalam proses dalam proses Puskesmas Kalasan 11/4/1970 3404100411700001 0000095957447
Vyga Afisatiarini, A.Md.Gz 446/5418/1272/IV-22 24 April 2022 Puskesmas Kalasan 24/4/1985 3404016404850004 0000204865378
Fajar Harini, A.Md.PK 446/3279/825/VII-18 dalam proses Puskesmas Kalasan 25/6/1982 3311096506820005 0000095963815
Mengetahui
Kepala Puskesmas Kalasan
dr. DINI THREES HARJANTI
KELENGKAPAN DATA PEGAWAI
dr. Dini Threes Harjanti 446/2550/174/I-22 07 Januari 2022 Puskesmas Kalasan 1/7/1975 3404124507690005 0000095973063
dr. Izza Hidayati 446/10347/1108/7730/IV-23 12 April 2023 Puskesmas Kalasan 4/12/1976 1505025204760007 0000095970071
dr. Tentrem Rianita 446/3439/238/5629/VII-20 30 Juli 2020 Puskesmas Kalasan 7/7/1985 3404074707850003 0002230486525
dr. Nurul Anisa 446/4499/1125/XII-22 04 Desember 2022 Puskesmas Kalasan 12/4/1991 3402144412910002 0001901242269
dr. Elisa Fauziyatul Munawaroh 446/7279/1323/X-24 15 Oktober 2024 Puskesmas Kalasan 10/15/1989 3507185510890004 0000075245411
dr. Tsulutsi Nabilla Salim 446/7992/605/III-23 17 Maret 2023 Puskesmas Kalasan 3/17/1992 3374064407930005 0000075748522
drg. Febbia Thartika 446/7465/975/7601/VIII-21 20 Agustus 2021 Puskesmas Kalasan 20/08/1975 3404076008750008 0000205570484
Nur Djannah Alboneh,S.Far.Apt 446/7732/1645/IV-22 24 April 2022 Puskesmas Kalasan 24/04/1978 3471016404780001 0000094331968
Isti setiyaningsih,A.Md 446/7803/7315/V-21 16 Mei 2021 Puskesmas Kalasan 16/5/1983 3310125605830001 0000096268959
Rahma Maratus Sholihah 446/7802/7314/X-20 17 Oktober 2020 Puskesmas Kalasan 5/6/1988 3404014506880008 0000095664903
Impala, AMK 446/2681/4961/VIII-20 15 Agustus 2020 Puskesmas Kalasan 15/8/1966 3404105508660003 0000095963613
Sriyati Sipora, S.Kep 446/7537/7238/VIII-21 05 Agustus 2021 Puskesmas Kalasan 5/8/1969 3404104508690007 0000095964142
Sri Utami, AMK 446/6743/5800/VI-20 14 Juni 2020 Puskesmas Kalasan 14/6/1977 3404075406770007 0000022786165
Priyanto, AMK 446/1081/7810/V-20 23 Mei 2020 Puskesmas Kalasan 23/5/1974 3404112305740001 0000095970295
Niluh Nonik Wamiasih, AMK 446/6780/5801/III-20 29 Maret 2020 Puskesmas Kalasan 29/3/1966 3404106903660001 0000095963769
Bagus Hadi Sulistyo, AMK 446/3624/5183/I-20 08 Januari 2020 Puskesmas Kalasan 7/27/1977 3520020801880001 0000201518469
Dwi Mujiyanto, AMK dalam proses dalam proses Puskesmas Kalasan 13/5/1970 3310261305700004 000095963501
Retno Sunaringtyas, AMK 446/10136/2111/VII-20 27 Juli 2020 Puskesmas Kalasan 27/7/1977 3404116707770007 0000095971239
Dudid Sudaryono, AMK 446/1083/7808/VI-20 10 Juni 2020 Puskesmas Kalasan 10/6/1969 3404101006690001 0000095972848
Linda Prasetyo Utami, A.Md.Kep 446/8152/3403/VI-24 09 Juni 2024 Puskesmas Kalasan 6/9/1992 3305204906920001 0000084154555
Agustinus Hendy Irawan, A.Md.kep 446/7089/3264/VIII-23 05 Agustus 2023 Puskesmas Kalasan 8/5/1985 3310260508850001 0001526645834
Surat Ijin Kerja Bidan
5 Bidan ceklist (di isi oleh
No Surat Ijin Praktik Masa Berlaku alamat Praktik Tanggal Lahir NO NIK NO BPJS Kesehatan keterangan petugas BPJS
Kesehatan)
Hastuti, A.Md.Keb 446/4808/1090/VI-20 09 Juni 2020 Puskesmas Kalasan 9/6/1968 3404094901680001 0000095963578
Widi Sih Winarni, A.Md.Keb 446/4810/1089/IV-20 08 April 2020 Puskesmas Kalasan 8/4/1966 3404084804660001 0000095964502
Nur Nugroho wati, A.Md.Keb 446/3641/6746/VI-20 12 Juni 2020 Puskesmas Kalasan 12/6/1989 3310015206890001 000020596809
Nastiti Handayani, A.Md.Keb 446/3643/6748/XI-20 18 November 2020 Puskesmas Kalasan 18/11/1982 3404105811820002 0000096270131
Supartini, A.Md.Keb 446/3645/6750/VI-20 28 Juni 2020 Puskesmas Kalasan 28/6/1965 3310016806650001 0000095964287
Dwi Winarti, A.Md.Keb 446/3640/6745/I-20 01 Januari 2020 Puskesmas Kalasan 1/1/1969 3310024101690005 0000096614559
Ufi Susilo Wardani, A.Md.Keb 446/6392/8484/XI-21 30 November 2021 Puskesmas Kalasan 30/11/1988 5271067011880002 0000210478105
Dyah Resminingsih, A.Md.Keb 446/7835/6124/VIII-20 15 Juli 2020 Puskesmas Kalasan 15/8/1984 3404075508840005 0000197760363
Aan Antasari, A.Md.Keb 446/3642/6747/II-20 15 Februari 2020 Puskesmas Kalasan 15/2/1985 3404105502850002 0000198421457
Retno Dhamayanti, A.Md.Keb 446/6618/8616/III-21 18 Maret 2021 Puskesmas Kalasan 18/3/1974 3404105803740001 0000976128592
Fedelis Galuh Wulan, A.Md.Keb 446/6624/8622/VI-22 10 April 2022 Puskesmas Kalasan 10/4/1986 3402125004860005 0000199235654
Sri Utami, AMKG 446/10353/9795/VII-22 18 Juli 2022 Puskesmas Kalasan 18/7/1969 3404085807690006 0000095957908
Restu Wulan Sari, AMKG 446/5564/1291/IX-21 29 September 2021 Puskesmas Kalasan 9/29/1983 3402156909830001 0000173739295
Sri Sulastri, AMAK 446/6440/8517/I-22 17 Januari 2022 Puskesmas Kalasan 17/1/1973 3404085701730001 0000095964074
Darlistyana Kurniasari, A.Md 446/10033/9680/VIII-22 19 Agustus 2022 Puskesmas Kalasan 19/81988 3520115908880001 0000198767204
Ruky Desha Ratmaning Tiyas, A.Md 446/6718/5775/XII-19 08 Desember 2019 Puskesmas Kalasan 8/12/1989 3404104812890003 0000095160633
Catur haryati Juliana, S.SiT 446/10105/9706/VII-22 21 Juli 2022 Puskesmas Kalasan 21/7/1977 340214610770001 0000095972826
V.linariyati, AMKL 446/10104/9705/I-22 22 Januari 2022 Puskesmas Kalasan 22/1/1968 3471136201680003 0000095957234
Gandung Waluyo, AMG 446/6525/3177/XI-23 04 November 2023 Puskesmas Kalasan 11/4/1970 3404100411700001 0000095957447
Vyga Afisatiarini, A.Md.Gz 446/5418/1272/IV-22 24 April 2022 Puskesmas Kalasan 24/4/1985 3404016404850004 0000204865378
Fajar Harini, A.Md.PK 446/7136/1572/VI-23 25 Januari 2023 Puskesmas Kalasan 25/6/1982 3311096506820005 0000095963815
Mengetahui
Kepala Puskesmas Kalasan
1 Dokter Umum
No Surat Ijin Praktik Masa Berlaku
Su
2 Dokter GIGI
No Surat Ijin Praktik Masa Berlaku
3 Apoteker/Asisten Apoteker
No Surat Ijin Praktik Masa Berlaku
4 Perawat
No Surat Ijin Praktik Masa Berlaku
5 Bidan
No Surat Ijin Praktik Masa Berlaku
Surat
keteranga
Alamat Praktik Tanggal Lahir NO NIK KTP NO BPJS Kesehatan
n
keteranga
Alamat Praktik Tanggal Lahir NO NIK KTP NO BPJS Kesehatan
n
keteranga
alamat Praktik Tanggal Lahir NO NIK NO BPJS Kesehatan n
keteranga
alamat Praktik Tanggal Lahir NO NIK NO BPJS Kesehatan
n
ceklist (di
isi oleh
petugas BPJS
Kesehatan)
ceklist (di
isi oleh
petugas BPJS
Kesehatan)
ceklist (di
isi oleh
petugas BPJS
Kesehatan)
ceklist (di
isi oleh
petugas BPJS
Kesehatan)
ceklist (di
isi oleh
petugas BPJS
Kesehatan)