DAFTAR PESERTA PER SATUAN KERJA

DAFTAR PESERTA PER SATUAN KERJA Nama Satuan Kerja : DEPDIKBUD UNIBRAW No.

No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga

Tgl. Lahir Nama Faskes

1

0000085642064 3306014101860003

2013048601012 001

SRI UTAMI BUDI

PESERTA

01/01/1986

KLINIK BUNGA MELATI PANJAITAN

2

0000099740373 3578221006870002

2011028706101 001

EKO SETIAWAN

PESERTA

10/06/1987

dr. WINDA SABTIKARISA

3

0002218426165 3516085303930003

2011028706101 001

BUNGA HIDAYATI

ISTRI

13/03/1993


4

0000101425509 3578221207890002

2014058907121 001

TUBAGUS AGNIZARRIDLO

PESERTA

12/07/1989

GAYUNGAN

5

0000102363704 3573051208900003

2014079008122 101

ANDITO ARYO dwi PUTRO

PESERTA

12/08/1990


6

0000102397588 3573055508890004

2012058908152 001

AULIA RAHARJA

PESERTA

15/08/1989


7

0000102909565 3522092111870003

2011068711211 001

MAULFI SYAIFUL RIZAL

PESERTA

21/11/1987


8

0000104606504 3502206012870001

2012018712202 001

NIKO DIMA KRISTIANINGRUM

PESERTA

20/12/1987


9

0000104615234 3502180505900003

feb009

ANJIK FAHRUR HUDA

PESERTA

05/05/1990

DINOYO

10

0000104723414 3502175001900001

2014059001102 000

RETNO CAHYA KURNIASARI

PESERTA

10/01/1990

KLINIK DAQU SEHAT

11

0002218451804 3503102612890003

2014059001102 000

WAYAN ARTHA DHANA

SUAMI

26/12/1989

KLINIK DAQU SEHAT

12

0002218453929 3502176605100001

2014059001102 000

REYNATA CALYZTA KURNIA ARTHA

ANAK

26/05/2010

PONOROGO SELATAN

13

0002218454043 3502177105120001

2014059001102 000

RIBYTA CAPELLA KURNIA ARTHA

ANAK

31/05/2012

PONOROGO SELATAN

14

0002217934181 3517064802130001

2011038705201 001

JASMINE PUTRI KIRANA

ANAK

08/02/2013

MOJOAGUNG

15

0002217879382 3317060106830008

000

KHOIRON

SUAMI

01/06/1983

KEPANJENKIDUL

1/31/17 4:02 PM

Page 1 of 91

Nama Satuan Kerja : DEPDIKBUD UNIBRAW No.

No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


16

0002217879461 3572013101130002

000

MOHAMMAD ABDUL MALIK ADZAKI

ANAK

31/01/2013

KEPANJENKIDUL

17

0000110198619 3573015201890003

2014058901122 001

AGRI KALTARIA ANISA

PESERTA

12/01/1989

MUNSIFAH Z, dr

18

0000110198788 3573014705860002

2012018605072 001

DEVINTA PUSPITA RATRI

PESERTA

07/05/1986


19

0000110210567 3507164810870001

2014058710082 001

FITRI AMALIA RAHMAWATI

PESERTA

08/10/1987

TUMPANG

20

0000110247748 3507225301900001

2012059001132 200

FATMAMIA PUTRI MEGAWATI

PESERTA

13/01/1990

PUSKESMAS DAU

21

0000110506206 3507214203900001

2014059003022 001

AMALIA WARDANI

PESERTA

02/03/1990

ENI SUPRAPTI, dr

22

0000110578487 3573021310860002

2012028610131 001

KHARISMA KUMBARAKARTA

PESERTA

13/10/1986

UPTD PELKES. KAB, MALANG

23

0000111085255 3507094901870001

2011038701092 001

VITA NUR MUFIDAH

PESERTA

09/01/1987

KENDAL KEREP

24

0000111225521 3573044601900005

2013039001062 001

RIKA CANDRA WANDAYU

PESERTA

06/01/1990

TEGUH SATRIONO,MARS, dr

25

0000111239684 3573021811860003

2014068811181 001

MUH JUSRIANSYAH

PESERTA

18/11/1986

SRI HAYATI, dr

26

0000111241192 3573016506620006

2011086206252 001

YOENI ASRIATI BSC

PESERTA

25/06/1962

RAMPAL CELAKET

27

0000111290613 3507226601900002

2013099001262 001

AULIA RISKA IASTIKA

PESERTA

26/01/1990

M. YAZID, dr

28

0002218466529 3573052102160001

2013099001262 001

emir alfaruq arfan sidqi

ANAK

21/02/2016

M. YAZID, dr

29

0000111507941 3573025201860005

2010078601122 001

YANIAR IMMAWATI

PESERTA

12/01/1986

ADHANIAR A., dr

30

0000111602272 3573026508850004

2012058508252 001

PUTI REINARNY

PESERTA

25/08/1985

BP WIRA HUSADA (AD)

31

0002217917237 1218130902830002

2012058508252 001

BAYU KARNO ARDI MULYANTO

SUAMI

09/02/1983

BP WIRA HUSADA (AD)

1/31/17 4:02 PM

Page 2 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


32

0000111633118 3573024605870004

2013068705062 001

MAYRINA RESTUNINGTYAS, SE

PESERTA

06/05/1987


33

0000111775781 3573011711860003

2015038611170 01

MAHENDRA DATA

PESERTA

17/11/1986


34

0002218430169 3573016207910007

2015038611170 01

TIRANA NOOR FATYANOSA

ISTRI

22/07/1991


35

0000111821668 3573046811900002

2014059011282 001

HANINDYAS CAHYANING NOVITA

PESERTA

28/11/1990


36

0000111846824 3573026811880001

2011118811282 001

NOVA ERSIANDA

PESERTA

28/11/1988

DINOYO

37

0000111874735 3507222202880004

2013038802221 001

MOCH. AGUNG KURNIAWAN

PESERTA

22/02/1988

PUSKESMAS DAU

38

0000111886481 3573026802640002

2013036402282 001

LULUK HERNA KISWATI

PESERTA

28/02/1964


39

0000111890665 3573010308860002

2010018608061 001

BAMBANG MULYO UTOMO

PESERTA

03/08/1986

dr. JOKO SUWARSO

40

0000111891194 3573036604900004

2011119004262 001

REVI LORI FERLINA

PESERTA

26/04/1990

MUNSIFAH Z, dr

41

0000111894805 3507240405860005

2012058605042 101

EDWIN IBNU KAUTSAR

PESERTA

04/05/1986

ARDIMULYO

42

0000111909262 3573034910900006

2012029009102 01

WNDA SASTRA DEWI

PESERTA

09/10/1990

CISADEA

43

0002218931853 3573020210890001

2012029009102 01

ADITYO PRAYOGO, SE

SUAMI

02/10/1989

CISADEA

44

0002218932595 3573030911160001

2012029009102 01

damarazka aji prayogo

ANAK

09/11/2016

CISADEA

45

0000111912153 3579034103850002

2008128503012 001

SHANTY KUSUMAWARDHANI

PESERTA

01/03/1985

JUNREJO

46

0000111914188 3573056201900001

2013029001222 001

DWI ARI NINGSIH

PESERTA

22/01/1990

DINOYO

47

0000111917237 3573046005880005

2012018805202 01

PAMBAYUN WULAN UTAMI

PESERTA

20/05/1988

ENI SUPRAPTI, dr

1/31/17 4:02 PM

Page 3 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


48

0000111917823 3507224108880001

2012088808012 001

ALIF DIANTIKA PUSPITA

PESERTA

01/08/1988

DINOYO

49

0000111922773 3573051104850005

2011048504111 001

MOCH. LUTHFI ARISDIANTO

PESERTA

11/04/1985


50

0000111928893 3573032607860005

8607260721080 5

LIMBANG NIDIASMORO

PESERTA

26/07/1986

GRIBIG

51

0000111929668 3573013004860001

ubR007

AGI PUTRA KHARISMA

PESERTA

30/04/1986


52

0000111929692 3507210501870002

2012050701051 001

NANANG HARIYANTO

PESERTA

05/01/1987

WAGIR

53

0000111935801 3573056404720008

2010087204242 001

NUNIK YANA

PESERTA

24/04/1972


54

0002218461849 3573055708960006

2010087204242 001

atikah karimah

ANAK

17/08/1996


55

0002218461996 3573056111970001

2010087204242 001

afina mutiah tuhepaly

ANAK

21/11/1997


56

0000111941414 3507225901820004

8201191322038 5

TRI PUSPITASARI,

PESERTA

19/01/1982

BP KIMIA FARMA BROMO

57

0000111959199 3573051711900003

2012010117000 157

ALFIN YOGA ADITAMA

PESERTA

17/11/1990


58

0000111979484 3573023010930001

2012109310302 11

ENDY RANGGA PRASETYAWAN

PESERTA

30/10/1993


59

0000112061496 3573054111840002

feb008

RATNA SYIFAUN N

PESERTA

01/11/1984

PUSKESMAS DAU

60

0000112157662 3513166509920002

01

SITI MARUFAH ARIYANTI

PESERTA

25/09/1992

PAJARAKAN

61

0000112656532 3514096108860002

UBR008

FAIZATUL AMALIA

PESERTA

21/08/1986

DINOYO

62

0000115445136 3511112308890001

2012058908231 001

ADITYA PANDU WICAKSONO

PESERTA

23/08/1989

DINOYO

63

0000133735151 3573025905660003

2011036605192 001

ANDAYANI TATIK KORNIWATI

PESERTA

19/05/1966

BARENG

64

0000195115318 3573056308730003

2010087308232 001

AUSTRA WIYANTI

PESERTA

23/08/1973

KLINIK DAQU SEHAT

65

0000196961681 3573051212610009

2013036112121 001

ASMONO

PESERTA

12/12/1961

SUHARNOWO, dr

1/31/17 4:02 PM

Page 4 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


66

0000198435576 3522156508840002

2011048408252 001

ERA AGUSTINA

PESERTA

25/08/1984


67

0002219324073 3573052607110006

2011048408252 001

MUHAMMAD KEENAN AGASTYA

ANAK

26/07/2011


68

0000199148387 3573021008850002

2008088508101 001

MIRZAH ARDIANSYAH

PESERTA

10/08/1985

AGUNG TRISNO, dr

69

0000206048248 3674010410840001

2013098410041 001

M. ARFAN LESMANA

PESERTA

04/10/1984


70

0000209374143 3507222904910001

9104291321000 1

GILANG RAMADHAN

PESERTA

29/04/1991

CATUR SUCI SUTRISNANI, dr

71

0000976550591 3573034807870013

2010078707082 001

INNA HANIFA TAUHID

PESERTA

08/07/1987

dr. BAMBANG PRIJADI (JST)

72

0001038727743 3507222902680001

6802291321000 1

SUPRAYITNO

PESERTA

29/02/1968

PUSKESMAS DAU

73

0001038727754 3507225206750002

6802291321000 1

ANI PRASETYO RINI

ISTRI

01/04/1974

PUSKESMAS DAU

74

0001038727765 3507220502000002

6802291321000 1

MOHAMMAD DIMAS

ANAK

01/01/2003

PUSKESMAS DAU

75

0001038727776

6802291321000 1

NIMAS

ANAK

01/02/2006

PUSKESMAS DAU

76

0001078827783 3573041510840002

3573041510840 002

HERRY SATRIO

PESERTA

15/10/1984

SUKODONO

77

0001079225583 3573051101770006

BOBBI HARI SISWANTO

PESERTA

11/01/1977

KLINIK MELATI

78

0001098338771 3573055201900004

2012059001122 200

ADHITA PURWITASARI

PESERTA

12/01/1990

POLRES MALANG KOTA

79

0001101065229 3573045304660001

2013016604132 001

LUSMIARSIH

PESERTA

13/04/1966


80

0001101126677 3518086103850001

UBR0049

MARTINA PURWANING DIAH

PESERTA

21/03/1985

POLRES KEDIRI KOTA

81

0001170946732 3573055907790002

7907191322032 2

SITI KURNIAWATI

PESERTA

19/07/1979

dr. WULANDARTI WIEN W. (JST)

82

0002218921391 3573054606150003

7907191322032 2

GENIO ASYIFAH

ANAK

06/06/2015

dr. WULANDARTI WIEN W. (JST)

1/31/17 4:02 PM

201302770111100100

Page 5 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


83

0001186888904 3574014412760003

2012027612042 001

DIAN RIZKYANA

PESERTA

04/12/1976

KLINIK CITRA 18

84

0001188937181 3573016005870003

2013038705202 001

NIA RAMADHANI

PESERTA

20/05/1987


85

0001133840474 3573030409870004

2013038705202 001

ERIK CHRISYANTO

SUAMI

04/09/1987


86

0001294312386 3573010810130001

2013038705202 001

HABIBI RIDHO PRATAMA

ANAK

08/10/2013


87

0001190371869 3573045701830004

2008128301172 001

HENNY SARASWATI

PESERTA

17/01/1983


88

0001196464037 3573054303830007

2008088303032 001

FRIDA IKA HARTINA

PESERTA

03/03/1983


89

0001202182626 3573053101830020

2010078301311 001

DHIMAZ SECTIO

PESERTA

31/01/1983

KLINIK 24 JAM GRIYA BROMO

90

0001204981863 3573044107870034

2012058707012 001

RATNA SRI HARTATIK

PESERTA

01/07/1987

HAYUNANTO MEDICAL CENTER

91

0001245885118 3573020304860002

2008128604031 001

OVAN HARWANTO

PESERTA

03/04/1986

KLINIK MELATI

92

0001245885096 3573026405890001

2008128604031 001

INTAN ROFI LIANDINI

ISTRI

24/05/1989

KLINIK MELATI

93

0001245885129 3573022204100003

2008128604031 001

ACE RUFI ARVEANT ARMANDO H

ANAK

22/04/2010

KLINIK MELATI

94

0002218889406 3573020608150006

2008128604031 001

GERALD HAIDAR

ANAK

06/08/2015

KLINIK MELATI

95

0001260061626 3573056602900002

2008119002262 001

NURAFNI LISA SAVITRI

PESERTA

26/02/1990

KLINIK MELATI

96

0001260060614 3573033010860005

2008119002262 001

DAUD AKBAR

SUAMI

30/10/1986

KLINIK MELATI

97

0002218942798 3573056311140002

2008119002262 001

MAHWA SABIYAH HANAN

ANAK

23/11/2014

KLINIK MELATI

98

0001260219374 3524040702800001

ubr0064

M. RIZA HANAFI

PESERTA

07/02/1980


99

0001260580138 3573025510870001

2012058710152

OKTAVIANTRI ANJANI

PESERTA

15/10/1987

M. YAZID, dr

1/31/17 4:02 PM

Page 6 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


001 100

0001483894416 3509121112840004

2012058710152 001

MUHAMMAD ARIFIN

SUAMI

11/12/1984

M. YAZID, dr

101

0001483899658 3573021302140001

2012058710152 001

FABIAN ALGHAAZIY AP

ANAK

13/02/2014

M. YAZID, dr

102

0001272805571 3573050804840005

2009128404081 0

SYAMSUL ARIFIN

PESERTA

08/04/1984

KLINIK MELATI

103

0001272805931 3578236402630002

2009128404081 0

tri widiyanti

ISTRI

24/02/1983

KLINIK MELATI

104

0001272806166 3573051103110004

2009128404081 0

raditya ahmad arfiyan

ANAK

11/03/2011

KLINIK MELATI

105

0001822771517 3573056804140001

2009128404081 0

raline falisha arfiyan

ANAK

28/04/2014

KLINIK MELATI

106

0001278492366 3579012909810001

01

DWI ANDIYAS KURNIAWAN

PESERTA

29/09/1981

dr. FAUZUL WILDAN SUAIDI

107

0001278492794 3579015207830002

01

FITRIYAH RAHMAWATI

ISTRI

12/07/1983


108

0001284053635 3573035405850002

2008018505142 001

TANTRI ARDHIANA SPD

PESERTA

14/05/1985

KLINIK MELATI

109

0001961217371 3515042107800006

2008018505142 001

SUTIONO, ST

SUAMI

21/07/1980

DYAH PALUPI, dr

110

0001836059139 3573031001100002

2008018505142 001

SAFARAZ JENARO TIOARDIAN ANAK

10/01/2010

DYAH PALUPI, dr

111

0001961218539 3573035601160003

2008018505142 001

JANESHA CORDELIA TIOARDHIAN

ANAK

16/01/2016

DYAH PALUPI, dr

112

0001288507961 3504185101820001

01

IKA ADITA SILVIANDARI

PESERTA

11/01/1982


113

0001288507735 3504181605790002

01

ALDI AGUNG PERMANA

SUAMI

16/05/1979


114

0001288508049 3504186812080002

01

LAISYA CITU PERMANA

ANAK

28/12/2008


115

0001294039517 3578146705890002

221

DITA RACHMAYANI

PESERTA

27/05/1989

NAYAKA HUSADA 02 (JST)

116

0001296117483 3573010802820001

45465697

MUHAMMAD HADI WIBOWO

PESERTA

08/02/1982

REJEKININGDIAH, dr

117

0001296118899 3573015409870001

45465697

RIZKY MAULIDIYAH

ISTRI

14/09/1987

REJEKININGDIAH, dr

118

0001296119215 3573011609100002

45465697

MUHAMMAD ZULFIKAR IRHAB ANAK

16/09/2010

REJEKININGDIAH, dr

1/31/17 4:02 PM

Page 7 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


WIBOWO 119

0001881048791 3573052310150002

45465697

muhammad zufar rizqullah wibowo

ANAK

23/10/2015

TJAHJONO RAHARDJO, dr

120

0001298020318 3506045103780004

2013017803112 001

SITI NAHARLINA, S.PD

PESERTA

11/03/1978

BP MEDIKA KELUARGA

121

0002218463267 3506046705140001

2013017803112 001

KAYLA ZAHIRA KAMIL

ANAK

27/05/2014

BP MEDIKA KELUARGA

122

0001301233195 3506045706740002

7406170220045

WAHYUNI RITA SARI

PESERTA

17/06/1974


123

0001301232137 3506041008690002

7406170220045

SUKITNO

SUAMI

10/08/1969


124

0001301234411 3506044912060001

7406170220045

AQILA NAJIA PUTERYKITTA

ANAK

09/12/2006


125

0001301775243 3573015303840006

2006088403132 001

RINI FATMAWATI

PESERTA

13/03/1984

ARIF YAHYA, dr

126

0001301775118 3507180409840003

2006088403132 001

ILHAM YUDHA PRATAMA

SUAMI

04/09/1984

ARIF YAHYA, dr

127

0001306148174 3573015803650001

2012086503182 001

FADLILAH

PESERTA

18/03/1965


128

0001306148747 3573014508940001

2012086503182 001

anandya asprillia

ANAK

05/08/1994


129

0001307543106 3507184412820006

200509821204100100

WURI FITRIATI UTAMI

PESERTA

04/12/1982

ARIF YAHYA, dr

130

0001307542094 3507182503780001

200509821204100100

SUPRIADI

SUAMI

25/03/1978

ARIF YAHYA, dr

131

0001307545007 3507185510060002

200509821204100100

PRITA LANA PARINGGA

ANAK

15/10/2006

ARIF YAHYA, dr

132

0001307545659 3507181510080001

200509821204100100

SUTHA WIJAYA ANORAGA

ANAK

15/10/2008

ARIF YAHYA, dr

133

0002197104974 3507185712160001

200509821204100100

dita tjiptaning mulia

ANAK

17/12/2016

ARIF YAHYA, dr

134

0001308243137 3573055202820001

2012088102122 001

WULAN PINARINGSIH

PESERTA

12/02/1982

REJEKININGDIAH, dr

135

0001308242496 3507050806860008

2012088102122 001

SULISTIONO

SUAMI

08/06/1986

REJEKININGDIAH, dr

136

0001308243835 3573055712100001

2012088102122 001

TITAH QUINATHIFA HERSASI

ANAK

17/12/2010

REJEKININGDIAH, dr

137

0001314222039 3573046005890004

2015038905202

RATIH KARTIKA DEWI, ST

PESERTA

20/05/1989

JANTI

1/31/17 4:02 PM

Page 8 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


001 138

0001317492167 3507194904860002

2012098604092 001

RETNA WULANDARI

PESERTA

09/04/1986

JANTI

139

0001319499887 3506126101890004

2010098901212 001

SITI ZULAIKHAH

PESERTA

21/01/1989

GAMPENGREJO

140

0002218847319 3571023101160001

2010098901212 001

MUHAMMAD AHZA AL FATIH

ANAK

31/01/2016

GAMPENGREJO

141

0001339433493 3573055305780001

2013097925132 001

SUSILOWATI, S.SOS, M.AB

PESERTA

13/05/1978

KENDALSARI

142

0001339436272 3573052012000005

2013097925132 001

NOVAN PRAMUDYA BINTORO ANAK

20/12/1999

KENDALSARI

143

0002044935325 3573055811080003

2013097925132 001

keyla almira aureliva

ANAK

18/11/2008

KENDALSARI

144

0001340127426 3573042004800009

2010078004201 001

M.FATCHUR ROCHIM

PESERTA

20/04/1980

REJEKININGDIAH, dr

145

0001340167454 3507224507920003

2010078004201 001

ANIFATUL NGATMIATI

ISTRI

05/07/1992

REJEKININGDIAH, dr

146

0001340162987 3573041602130002

2010078004201 001

MUHAMMAD SIROJUL MUNIR

ANAK

16/02/2013

REJEKININGDIAH, dr

147

0002198564403 3573040802130011

2010078004201 001

calon by ny ANIFATUL NGATMIATI

ANAK

04/11/2016

dr. IRMA SUSWATI (JST)

148

0001370540619 3573044404850010

2014058504042 001

INNEKE KUSUMAWATI

PESERTA

04/04/1985

KLINIK MELATI

149

0001378237184 3516084607820000

2008108207062 001

PERTIWI DHEVIANA PALUPINING DYAH

PESERTA

06/07/1982


150

0001381288184 3507096009840001

2007118409202 001

ENIK SUSILOWATI

PESERTA

20/09/1984


151

0001384471023 3573032008860006

2012086082010 01

ROFI NURDIANSYAH

PESERTA

20/08/1986


152

0001384468097 3573044802890008

2012086082010 01

ANINDITA CHANDRAINTAN PRATHAMI

ISTRI

08/02/1989


153

0002061594393 3573040808140005

2012086082010 01

MUHAMMAD UMAR ABDURRAHMAN SAYEKTI

ANAK

08/08/2014

KENDAL KEREP

1/31/17 4:02 PM

Page 9 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


154

0002061596024 3573041209140003

2012086082010 01

CALON BAYI NY ANINDITA CHANDRAINTAN P

ANAK

26/05/2016

KENDAL KEREP

155

0001390128941 3573044211920003

2011109211022 001

LUSI NURSITASARI

PESERTA

02/11/1992


156

0001724716247 3507151502850002

2011109211022 001

MOHAMMAD HADHORI

SUAMI

15/02/1985


157

0001724716258 3507151201150001

2011109211022 001

ALDZIKRA NABIL ANANDO DHORIUS

ANAK

12/01/2015


158

0001407371861 3573054402850005

2011108502042 001

FIDA RAHMAYANTI

PESERTA

04/02/1985


159

0001407673078 3573055512850002

2014058512152 001

WIDYA KARTIKA SARI

PESERTA

15/12/1985

ADHANIAR A., dr

160

0001407857466 3510071708860009

feb016

AGUS WIDYATAMA

PESERTA

17/08/1986

KLINIK MELATI

161

0001421294747 3575035810790001

2011117910182 001

SULISTYO RESTANTI

PESERTA

18/10/1979

KLINIK MELATI

162

0001421298516 3575030605790002

2011117910182 001

LUKIK VIDIANTO

SUAMI

06/05/1979

KLINIK MELATI

163

0001421300553 3575030601090001

2011117910182 001

FADHIL ARYA MAULANA

ANAK

06/01/2009

KLINIK MELATI

164

0002218760133 3573024901150001

2011117910182 001

DINARA AULIA SAFINA

ANAK

09/01/2015

KLINIK MELATI

165

0001423177672 3573052509740005

2011112409251 001

NUGROHO TRI CAHYONO

PESERTA

25/09/1974

KLINIK WIDYA HUSADA

166

0001423179898 3573057103110004

2011112409251 001

HASNA NUR AFIFAH

ANAK

31/03/2011

KLINIK WIDYA HUSADA

167

0002203037741 3573051303150002

2011112409251 001

MUHAMMAD AZZAM ARRAYYAN

ANAK

13/03/2015

KLINIK WIDYA HUSADA

168

0001423179112 3573056302740000

WURI WURYANINGTYAS

PESERTA

23/02/1974

KLINIK WIDYA HUSADA

169

0001430933758 3573012002870004

2014048702201 001

FAISHAL FADLI

PESERTA

20/02/1987

KLINIK MELATI

170

0001430934603 3506174712870003

2014048702201 001

vietha devia ss

ISTRI

07/12/1987

KLINIK MELATI

1/31/17 4:02 PM

002006047402232001

Page 10 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


171

0001434494035

2014048702201 001

FAIVIE KHADIJAH ALI

ANAK

06/09/2014

KLINIK MELATI

172

0001435795053 3573055701820002

8201171322069 5

INDRIE KURNIAWATI

PESERTA

17/01/1982


173

0001435794366 3573051905810007

8201171322069 5

SONI WAHYUDI

SUAMI

19/05/1981


174

0001437509654 3579012409890001

009

SEBRIAN MIRDEKLIS BESELLY PESERTA

24/09/1989

dr. SRI RAHATI (JST)

175

0002217487239 3507136107900005

009

SISKA ADINATA RAHMAN

ISTRI

21/07/1990

dr. SRI RAHATI (JST)

176

0001438982122 5201080706840002

2011068406071 001

AHMAD FAUZI

PESERTA

07/06/1984

KLINIK RAWAT JALAN ONTOSENO

177

0001438984787 3573056201860003

2011068406071 001

NURINA TITISARI

ISTRI

22/01/1986


178

0001438986868 3573051307120006

2011068406071 001

KEANE MAULANA ALKHALIFI ARSHAD

ANAK

13/07/2012


179

0002218382019 3573051704150001

2011068406071 001

KAMIL AHSAN APRILIO

ANAK

17/04/2015


180

0001445350724 3507214905870001

2014048705092 201

CITRA MERRYNA KINANTHI

PESERTA

09/05/1987


181

0001448832161 3573056706850002

2008038506272 001

EVA WULANDARI

PESERTA

27/06/1985

DINOYO

182

0001449011147 3573046910890004

2011038910292 001

PHEBY ISABELLA

PESERTA

29/10/1989

MULYOREJO

183

0001450011666 3573010611860007

2012068611062 11

DHIKA WIRYA DIPRAJA

PESERTA

06/11/1986

DYAH PALUPI, dr

184

0001450997897 3573016707810003

2007118107272 001

TANTRI RISTIKAWATI

PESERTA

27/07/1981

KENDAL KEREP

185

0001450998426 3522070805830002

2007118107272 001

JOHAN WAHYUDHI

SUAMI

08/05/1983

KENDAL KEREP

186

0001451000338 3573014203120006

2007118107272 001

KAYLA VALENCIA JASMINE

ANAK

02/03/2012

CISADEA

187

0001451562006 3573022910730004

2011473102910 01

ALFAN EFENDI

PESERTA

29/10/1973

BARENG

1/31/17 4:02 PM

Page 11 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


188

0001451562434 3573024707810010

2011473102910 01

SUMARNI

ISTRI

07/07/1981

BARENG

189

0001451562928 3573025208010004

2011473102910 01

IMAMAH ZAHROH

ANAK

12/08/2001

BARENG

190

0001451565088 3573026910060002

2011473102910 01

SAFFANAH ALYA NAFISAH

ANAK

29/10/2006

BARENG

191

0001451565461 3573026606090001

2011473102910 01

LAILY NASYWA AZIZAH

ANAK

26/06/2009

BARENG

192

0001453621601 3573057108850004

5555555

ETTY CAROLINA

PESERTA

31/10/1985

REJEKININGDIAH, dr

193

0001453713456 3573044907820014

2012058207092 001

AULIA DYANROSI

PESERTA

09/07/1982

KLINIK ELISA

194

0001454199614 3573054502830010

2009119302052 001

WINDA SABTIKARISA

PESERTA

05/02/1983


195

0001478438572 3514031604820001

2009119302052 001

LUKMAN HAKIM HIDAYAT

SUAMI

16/04/1982


196

0001478441722 3573054704120003

2009119302052 001

KAIRA SHAQUILLA AZZAHRA

ANAK

07/04/2012


197

0001854012971 3573050702150002

2009119302052 001

MUHAMMAD AZZAM HIDAYAT

ANAK

07/02/2015


198

0001454793298 3516162209850002

2011068509221 001

FARID JAUHARI

PESERTA

22/09/1985


199

0001785350992 3507234607890002

2011068509221 001

WENTY YOLANDA ELIYAWATI

ISTRI

06/07/1989


200

0002218938851 3507231103150001

2011068509221 001

RAIHAN NDARU MUHAQI

ANAK

11/03/2015


201

0001454872599 3509212812870001

2012058712821 001

NUGROHO MADIANTOKO

PESERTA

28/12/1987


202

0002092990432 3573056411160002

2012058712821 001

RANIA NISKI ALFATHUNNISA

ANAK

24/11/2016


203

0001455741764 3573031908880003

2013018808191 001

DOMMY ADI PUTRA JAYA Laksana

PESERTA

19/08/1988

SRI HAYATI, dr

204

0001455752935 3573051911850010

2008128411191

TAUFIK ARIYANTO

PESERTA

19/11/1985

REJEKININGDIAH, dr

1/31/17 4:02 PM

Page 12 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


001 205

0001457765919 3516135211870005

2008128411191 001

NOVI PUSPITASARI,S.SI

ISTRI

12/11/1987

REJEKININGDIAH, dr

206

0001457766011 3573055402140002

2008128411191 001

ANNISA HASNA SYARAFANA ATSILAH

ANAK

14/02/2014

REJEKININGDIAH, dr

207

0001457768068 3573055103670002

2008128411191 001

KASYATI

TAMBAHAN

11/03/1967

REJEKININGDIAH, dr

208

0001457768542 3573050809910001

2008128411191 001

AAN WIJAYA

TAMBAHAN

08/09/1991

REJEKININGDIAH, dr

209

0001456664141 3319051911810004

2013

SLAMET THOHARI

PESERTA

19/11/1981

JATI

210

0001458593021 3573026510740003

2010087410252 001

ERI WIDAYANTI

PESERTA

25/10/1974

ARJUNO

211

0001458615251 3509224112900002

2014059012012 001

BERLIAN GARI AMRINA

PESERTA

01/12/1990


212

0001458609941 3579031503890001

2014059012012 001

NASRUL AMIN

SUAMI

15/03/1989


213

0001884240955 3579034710150002

2014059012012 001

SHAKILA KHAWLA ZIVARA

ANAK

07/10/2015


214

0001459663097 3529015812870004

0000000000126 26

ANNISTI NURUL FAJRIYAH

PESERTA

18/12/1987


215

0001460184636 3515160204860002

2010088604021 001

HENRY ARY WARDANA

PESERTA

02/04/1986

BP JALA HUSADA

216

0001460208611 3515165112850003

2010088604021 001

DINANTI PREMITA HARYUTAMI ISTRI

11/12/1985

BP JALA HUSADA

217

0001460525242 3515163110110001

2010088604021 001

DZAKEANO EZCORTA EL HAFEEZY

ANAK

31/10/2011

BP JALA HUSADA

218

0001461022953 3573030811850004

2011048511081 001

A. TAMYIS ALI IMRON

PESERTA

08/11/1985


219

0001461750603 3528015505900008

2011048511081 001

HALIFATUS ZAR ZARAH

ISTRI

15/05/1990


220

0001461549341 3573020501790001

7901051321022 7

YUDIE WIRO EKO SETYAWAN PESERTA

05/01/1979

Klinik Hamid Rusdi

1/31/17 4:02 PM

Page 13 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


221

0001461550318 3573024412810010

7901051321022 7

DINA AULIA

ISTRI

04/12/1981

GRIBIG

222

0001461550869 3573024801080005

7901051321022 7

AISYAH QURROTA AINI

ANAK

08/01/2008

GRIBIG

223

0001461551354 3573011411090004

7901051321022 7

AHMAD NASHRI

ANAK

14/11/2009

GRIBIG

224

0001461551859 3573012307120005

7901051321022 7

AZKA KENZIE RAMDHANI

ANAK

23/07/2012

GRIBIG

225

0001461551916 3302166305730003

7901051321022 7

SALIYAH

TAMBAHAN

23/05/1973

GRIBIG

226

0001462795705 3573025410830003

8310141322038 1

LOITA MAYASARI

PESERTA

14/10/1983

ARJUNO

227

0001463717496 3510200107820081

2010018207011 001

SAIFUL ARIPIN

PESERTA

01/07/1982


228

0001463717507 3510206211830003

2008028311222 200

HENI ENDRAWATI

PESERTA

22/11/1983


229

0001463717518 3510202903100003

2008028311222 200

MUHAMMAD HABIBURAHMAN ANAK NURUS SYARIF

29/03/2010


230

0002061237802 3573045205150002

2008028311222 200

FATIMAH FAIZATUNNISA NURKAMILA

ANAK

12/05/2015


231

0001463909556 3573026809820009

feb002

IDA TRIASTUTI

PESERTA

28/09/1982

KENDAL KEREP

232

0001463909545 3573010904820002

feb002

PRATOMO IMAN SANTOSA

SUAMI

09/04/1982

KENDAL KEREP

233

0001463909567 3573011503120004

feb002

ANAS WICAKSANA PUTRA PRATOMO

ANAK

15/03/2012

KENDAL KEREP

234

0001464567028 3573053003750002

001

ANGGARA WIYONO WIT SAPUTRA

PESERTA

30/03/1975


235

0001464567039 3573055009760008

001

YENI SESTI ARININGSIH

ISTRI

10/09/1976


236

0001464567041 3573055203040003

001

RANI RAHMAWATI

ANAK

12/03/2004


237

0001464567052 3573054207070001

001

TARA ARTHASYA ZAFIRA

ANAK

02/07/2007


238

0001465067924 3573011209840001

2009068409121 001

ADHIE POEJO SOEHARTONO

PESERTA

12/09/1984

POLRES MALANG KOTA

1/31/17 4:02 PM

Page 14 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


239

0001465067935 6471044906870003

2009068409121 001

EMILIA SAFITRI INDRA

ISTRI

09/06/1987

POLRES MALANG KOTA

240

0001465067946 3573041001130002

2009068409121 001

AHMAD FAHMI IBRAHIM

ANAK

10/01/2013

POLRES MALANG KOTA

241

0002068381901 3573045007160002

2009068409121 001

arumi adzkiya zahra

ANAK

10/07/2016

dr. Ganina Widya Rini

242

0001467237014 3579031704860002

2010048604171 001

ARDIAN CANDRA SETYAWAN

PESERTA

17/04/1986


243

0001467237025 3579016407870003

2010048604171 001

DIAN PERMATASARI

ISTRI

24/07/1987


244

0001467237047 3579011310110002

2010048604171 001

ABBIYU BERYL DHAIFULLAH

ANAK

13/10/2011


245

0001467597791 3507184807860003

6656559

IRENE PARAMITA

PESERTA

08/07/1986


246

0002217485496 3507184606150001

6656559

ALODYA GLADDYTA TULLE

ANAK

06/06/2015


247

0001468149221 3513051503790001

01

MOHAMMAD HASAN

PESERTA

15/03/1979

REJEKININGDIAH, dr

248

0001468149232 3573056607790002

01

ANIK YULIATI

ISTRI

26/07/1979

REJEKININGDIAH, dr

249

0001468149254 3573052111120001

01

ADINATA HAYYUNAJI PRATAMA

ANAK

21/11/2012

REJEKININGDIAH, dr

250

0001468595215 3573056504880006

2011048804252 001

TANTINA ARYA WINANDA

PESERTA

25/04/1988

KENDALSARI

251

0001468595193 3573012704780006

2011048804252 001

ANTON SUPRANOTO

SUAMI

27/04/1978

KENDALSARI

252

0001468595248 3573050101130003

2011048804252 001

MUHAMMAD NAUFAL BISRI

ANAK

01/01/2013

KENDALSARI

253

0001470731782 3578106505830007

2007183052522 001

NURAINI,SE

PESERTA

25/05/1983

KLINIK MEDIS GELORA

254

0001470731793 3578104307090002

2007183052522 001

NABILA WARDATUD DINIYAH

ANAK

03/07/2009

KLINIK MEDIS GELORA

255

0001470731804 3578104405110005

2007183052522 001

SAFIRA MEYDA NUR FAUZIAH ANAK

04/05/2011

KLINIK MEDIS GELORA

256

0001471085278 3573051505780001

2010087805151 001

BAMBANG IRAWANTO

15/05/1978

KLINIK MELATI

1/31/17 4:02 PM

PESERTA

Page 15 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


257

0001471631231 3517094111710001

001

SRI AJU INDROWATY

PESERTA

01/11/1971

KLINIK ALIF MEDIKA

258

0001471631242 3517092303000001

001

MIRZA MUHAMMAD YUDHISTIRA

ANAK

23/03/2000

KLINIK ALIF MEDIKA

259

0001472242217 3573051812850002

ubr0022

SETIAWAN WICAKSONO, SH., M.KN.

PESERTA

18/12/1985

DINOYO

260

0001472242228 3573054809870002

ubr0022

FERNI MUSTIKA JUMRAH, SH., ISTRI M.KN.

08/09/1987

DINOYO

261

0001478372376 3573046803890006

ARIF MUDJAHIDAH

PESERTA

28/03/1989

REJEKININGDIAH, dr

262

0001482748997 3507021212800001

8012121321033 2

MUSTOFA

PESERTA

12/12/1980

PAKISAJI

263

0001482749313 3507025010850004

8012121321033 2

HERI DWI LESTARI

ISTRI

10/10/1985

PAKISAJI

264

0001482749482 3507025509070003

8012121321033 2

REVA RAHMANIA AZZAHRA

ANAK

15/09/2007

PAKISAJI

265

0001536059687 3573056702850006

feb001

CATRINE ANA PRASTYARI

PESERTA

27/02/1985

DINOYO

266

0001537945931 3573056102860002

0002301201702

FRIDA pUTRI SURYAWATI

PESERTA

21/02/1986

dr. HARDJITO

267

0001538513943 3573053005860001

2013018605301 001

BROTO PAMUNGKAS

PESERTA

30/05/1986

BENTOEL MEDICAL CENTRE SUKUN

268

0001538559156 3573025508850003

8508150822058 8

AULIA SARI

PESERTA

16/08/1985


269

0001539128823 3507124301850004

5202565203202 32

KRISTIE WULAN

PESERTA

03/01/1985


270

0001539128812 3573022404780002

5202565203202 32

HAVIZ SYAFRIL LINANTO

SUAMI

24/04/1978


271

0001539128834 3573025611120002

5202565203202 32

NAURA IZDIHAR HAFIZHA

ANAK

16/11/2012


272

0002219316107 3573026411140004

5202565203202 32

NAZNEEN ALYA HAFIZHA

ANAK

24/11/2014


273

0001539252483 3573045101800001

2010088001112 1

RINI

PESERTA

11/01/1980

KLINIK DAQU SEHAT

274

0001539252595 3573044604110002

2010088001112

ALMIRA IZZA HIMAWARI

ANAK

05/04/2011

KLINIK DAQU SEHAT

1/31/17 4:02 PM

201206890328220010

Page 16 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1 275

0001540064452 3514204702870003

2010088112272 003

SUSI IRAWATI

PESERTA

07/02/1987

dr. HARDJITO

276

0001540127204 3573056010900012

2013019010202 001

EKA DEWI SUSANTI

PESERTA

20/10/1990

SUMBERSARI

277

0002217917553 3573012509820003

2013019010202 001

STANLEY STEVANUS ROTINSULU

SUAMI

25/09/1982

SUMBERSARI

278

0002217917621 3573054709150003

2013019010202 001

CHELSEA CARRISA ROTINSULU

ANAK

07/09/2015

SUMBERSARI

279

0001540365028 3579016809860003

2010078609282 001

SITI RAHMASARI

PESERTA

28/09/1986

dr. YUNI ASTUTI

280

0001542912221 3507180103860003

2008028603011 001

ADIKA SETIA HADI

PESERTA

01/03/1986

KENDALSARI

281

0001542912219 3573054906860006

2008028603011 001

VIA NURFITRICA NINELA

ISTRI

09/06/1986

KENDALSARI

282

0001542912232 3507182802110002

2008028603011 001

CAESAR LEON ARARYA

ANAK

28/02/2011

KENDALSARI

283

0002218931572 3507182606150001

2008028603011 001

ananda athar ramadhan

ANAK

26/06/2015

KENDALSARI

284

0001543343815 3571016102850001

ubr0015

LILYA SUSANTI, ST MT.

PESERTA

21/02/1985


285

0001543800442 3579011201870003

2012068701122 101

FERIX PANJI ANDRIANTO

PESERTA

12/01/1987

MULYOREJO

286

0001543800453 3573045409920005

2012068701122 101

ELI DIANA

ISTRI

14/09/1992

MULYOREJO

287

0001543800464 3573040206140004

2012068701122 101

AbDAN FARASKEENAND Pradipta a

ANAK

02/06/2014

MULYOREJO

288

0001544198736 3507312806860001

2009078606281 001

KUKUH MAHENDRA ZAKARIA

PESERTA

28/06/1986

BP MUHAMMADIYAH (JST)

289

0001599844263 3573055602870005

3573055602870 005

DEWI WULAN PUTRIYANA

PESERTA

16/02/1987


290

0001601523775 3573054303830024

2010078303032 001

UYIK SHOLIHAH

PESERTA

03/03/1993

MULYOREJO

1/31/17 4:02 PM

Page 17 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


291

0001610050004 3505024104870001

2013028704012 001

AFIDATUL MUJI ASTUTI

PESERTA

01/04/1987

UDANAWU

292

0001619593031 3578106203860003

2010098603222 001

WORO AYU SATRYA PUTRI

PESERTA

22/03/1986

REJEKININGDIAH, dr

293

0001620168208 3573046209850002

2012018509222 001

SITI ANIYA

PESERTA

22/09/1985


294

0001620165126 3573050810780004

2012018509222 001

ABDUL HARIS

SUAMI

08/10/1978


295

0001620165295 3573040811120005

2012018509222 001

MOHAMMAD ADIB AQILA

ANAK

08/11/2012


296

0001623336625 3577036012890001

2014058912202 001

ZAHRA FIRDAUSYIA

PESERTA

20/12/1989

KLINIK MELATI

297

0001623336614 3506240904890001

2014058912202 001

ANDRYAS AFFANDI

SUAMI

09/04/1989

KLINIK MELATI

298

0002078696553 3506245209160001

2014058912202 001

SYAHIDAH ASMA AMANINA

ANAK

12/09/2016

KLINIK MELATI

299

0001624798282 3571025302880001

2013058802132 001

YOLANDA KUMALASARI

PESERTA

13/02/1988

DINOYO

300

0001638082045 3573044812840002

2010078412082 001

WAHYU WINARSIH

PESERTA

08/12/1984

AGUNG TRISNO, dr

301

0001638250727 3573056008860001

2009088608202 001

FUADIYAH NILA KURNIASARI

PESERTA

20/08/1986


302

0001638250716 3513061902830001

2009088608202 001

SONY ARIYANSAH

SUAMI

19/02/1983

DINOYO

303

0001638250738 3573057003120003

2009088608202 001

MAHIRA HASNA AKIFA KAMILA ANAK

30/03/2012


304

0002205843996 3573050210130012

2009088608202 001

CALON BAYI NY FUADIYAH NILA KURNIASARI

ANAK

06/12/2016

DINOYO

305

0001643004742 3573015902870004

200906870001

RISMA ARISONA

PESERTA

19/02/1987

RAMPAL CELAKET

306

0001644925702 3573046107830006

2010078307212 001

ASTRIA NINGSIH

PESERTA

21/07/1983

BP MUHAMMADIYAH (JST)

307

0001702156689 3578222005860002

RAKHMAD ROMADHONI

PESERTA

20/05/1986


1/31/17 4:02 PM

201205860520100110

Page 18 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


201205860520100110

AISYAH KHALISA RIZQIYANI

ANAK

19/06/2016


308

0002218457158 3573015906160002

309

0001703250369 3504032611870001

2013028711261 001

DANIS SETYA NANDIKA

PESERTA

26/11/1987

KOTA WIL SELATAN

310

0001716657175 3506104607820003

2010018207062 001

AMIMAYA HELDAYANTI S.KOM PESERTA

06/07/1982


311

0001716657164 3506103004840002

2010018207062 001

ANIS TRI BOWO

SUAMI

30/04/1984


312

0001716657186 3506104110120004

2010018207062 001

AHZA MAYAWIBOWO

ANAK

01/10/2012


313

0002218838499 3506100512150001

2010018207062 001

AHMAD ALFARIZY MAYAWIBOWO

ANAK

05/12/2015


314

0001717827388 3507211512750002

7512151310134

DIDIK CHOIRUDIN EFENDI

PESERTA

15/12/1975

KARANG PLOSO

315

0001717827399 3507216207770003

7512151310134

ISNULWATI

ISTRI

22/07/1977

KARANG PLOSO

316

0001717827401 3507214101000004

7512151310134

ANIN DIKA LAYUAR YURISQI

ANAK

01/01/2000

KARANG PLOSO

317

0001717827412 3507214806040001

7512151310134

JENINDHA YUAN NABIL

ANAK

08/06/2004

KARANG PLOSO

318

0001717827423 3507212712100002

7512151310134

MARCEEL ARIQ RAHMAWAN

ANAK

27/12/2010

KARANG PLOSO

319

0001718123027 3573034807780001

2006047807082 001

NOOR MACHNIN KUSUMANINGRUM

PESERTA

08/07/1978

DYAH PALUPI, dr

320

0001718123016 3573031011780001

2006047807082 001

NOVAN ADITYA PRABOWO

SUAMI

10/11/1978

DYAH PALUPI, dr

321

0001718123038 3573036109060013

2006047807082 001

HANA SADHVITONYA NABILAH ANAK

21/09/2006

DYAH PALUPI, dr

322

0001718123049 3573032111080005

2006047807082 001

HERNINO RIZQULAH

ANAK

21/11/2008

DYAH PALUPI, dr

323

0001718157857 3573025608810017

2005088108041 001

LINA DIAN PANGESTI

PESERTA

16/08/1981

KLINIK MELATI

324

0001718157846 3573022806820005

2005088108041 001

IRVAN WAHONI

SUAMI

26/06/1982

KLINIK MELATI

325

0001718157868 3573022208030007

2005088108041 001

MUHAMMAD AGATHA ARDHIANSYAH

ANAK

22/08/2003

KLINIK MELATI

1/31/17 4:02 PM

Page 19 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


326

0001718157879 3573027010060002

2005088108041 001

OKTANIA AULIA PUTRI

ANAK

30/10/2006

KLINIK MELATI

327

0001720121005 3518132907870001

2010018707291 001

RACHMAD TSALAATSA

PESERTA

29/07/1987


328

0001720121016 3518136503890001

2010018707291 001

ANA ABAD SYAKURA

ISTRI

25/03/1989


329

0002217907405 3518136302160001

2010018707291 001

alyssa hafizhah azzahra

ANAK

23/02/2016


330

0001720166027 3508107107830005

001

FITRIATUL AKHADIYAH

PESERTA

31/07/1983

PUSKESMAS DAU

331

0001720166016 3303042711810002

001

IMAM FAUZI SURAHMAT

SUAMI

27/11/1981

PUSKESMAS DAU

332

0001720166038 3508105002100002

001

AIRA KHANZA FAUZY

ANAK

09/02/2010

PUSKESMAS DAU

333

0001720166051 3508101308120002

001

ABIYAN FITRA FAUZY

ANAK

12/08/2012

PUSKESMAS DAU

334

0001720166073 3507221512140001

001

ALIYAN ARBANI MUCHSIN FAUZY

ANAK

15/12/2014

PUSKESMAS DAU

335

0001720511875 3507230512820001

2012028212051 001

SUNARTO

PESERTA

05/12/1982

KARANG PLOSO

336

0001720511886 3507236608830004

2012028212051 001

INDARTI AGUSTINA

ISTRI

26/08/1983

KARANG PLOSO

337

0001720511897 3507230303080002

2012028212051 001

ARIGHA PRASETYA DIANKUSUMA S

ANAK

03/03/2008

KARANG PLOSO

338

0001720511908 3507230608110001

2012028212051 001

RADITYA RAMADIAN KUSUMA ANAK SUNARTO

06/08/2011

KARANG PLOSO

339

0001720511919 3507236512140001

2012028212051 001

SKETSA AISYA SARAH SUNARTO

ANAK

25/12/2014

KARANG PLOSO

340

0001720709144 3573051611830010

2012207831116 211

PRANOE TATERPIGA

PESERTA

16/11/1983

KLINIK MELATI

341

0001720709155 3573055909880001

2012207831116 211

JUSEVIN CHRISTINAH

ISTRI

19/09/1988

KLINIK MELATI

342

0001721607423 3276022310820007

2011118210231 001

GEMAYEL.P

PESERTA

23/10/1982

Klinik Kanesha Medika

343

0001722244757 3573020608620002

PP11761

ASKAB RAIS, S.E

PESERTA

06/08/1962


1/31/17 4:02 PM

Page 20 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


344

0001722244779 3573025712590001

PP11761

NURUL ISTIANI

ISTRI

17/12/1959


345

0001722244792 3573027004020006

PP11761

SALSABILA

ANAK

30/04/2002


346

0001723619081 3579014412880006

2012018812041 001

DEARIKHA KARINA MAYASHINTA

PESERTA

04/12/1988

BATU

347

0001722314744 3276020409870013

2012018812041 001

PUJI RAHMAN

SUAMI

04/09/1987

BATU

348

0001722314755 3579014409120001

2012018812041 001

AYNAA SALSABILA

ANAK

04/09/2012

BATU

349

0001723801724 3573050707730002

2014017307071 001

YUDAN SETIAWAN

PESERTA

07/07/1973

DINOYO

350

0001425981745 3529027008800001

2014017307071 001

ZULFA

ISTRI

30/08/1978

DINOYO

351

0001723801735 3573056908140003

2014017307071 001

SYAFIRA SALSABILA

ANAK

29/08/2014

DINOYO

352

0001724464359 3506260701820001

2012028207011 001

MUHAMMAD IMRON HAMDANI PESERTA

07/01/1982


353

0001724464361 3503145612830001

2012028207011 001

RAHMA WIDIYANITA

ISTRI

16/12/1983


354

0001724464372 3506266003140002

2012028207011 001

MAZAYA UFAIRA HAMDANI

ANAK

20/03/2014


355

0001738345555 3516096307860001

2010078607232 001

YULI ALFIANA

PESERTA

23/07/1986

KENDALSARI

356

0001740672303 3507226304880000

2012058804232 001

WAHYU NUR LAILI FAJRI

PESERTA

23/04/1988

TENGGILIS

357

0002217530294 3507224312150001

2012058804232 001

DZAKIYAH TALITHA SAKHI

ANAK

03/12/2015

TENGGILIS

358

0001785575867 3518036702890003

01

NUR KHALISOTUL HAYATI

PESERTA

27/02/1989


359

0001785576543 3507220511830004

01

HADI SANTOSO

SUAMI

05/11/1983


360

0002218940864 3507221912140001

01

MUHAMMAD NAUFAL HANIF SANTOSO

ANAK

18/12/2014


361

0001789739155 3573026207900002

2008129007222 001

TRIAS YULIANI

PESERTA

22/07/1990


1/31/17 4:02 PM

Page 21 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


362

0001789736725 3573051005800006

2008129007222 001

ROLES MAY SUGIARTO

SUAMI

10/05/1980


363

0001795212156 3573051705810003

2012038105171 001

HERDANU ARDANANG. SE

PESERTA

17/05/1981

Klinik Panti Rahayu

364

0001795221426 3573052904830001

6565656565

FRIZA AMARANTHA. SE

PESERTA

29/04/1983

Klinik Panti Rahayu

365

0001797413613 3573055301780001

7801131322010 5

ANIK INDRIANI

PESERTA

13/01/1978


366

0001800521471 3573052908840010

007

MUHAMMAD SATYA ADHITAMA

PESERTA

29/08/1984


367

0001800632215 3573010907870002

0002301201701

INDRA SETYAWAN

PESERTA

09/07/1987

KLINIK MELATI

368

0001804198869 3578291610730002

2010087310161 01

ARIEN HADHI WIBOWO

PESERTA

16/10/1973

SRI HAYATI, dr

369

0001807329385 3504021312850001

2013098512131 001

TRI AFIRIANTO

PESERTA

13/12/1985

dr. ITA FARICA

370

0001807928943 3573054805880001

2011068805082 001

MEGAWATI KUSUMA, S.GZ

PESERTA

08/05/1988

KLINIK MELATI

371

0001808566075 3507222809830003

2012012809831 001

ANGGA DHETA SHIRAJJUDIN AJI

PESERTA

28/09/1983


372

0001808994025 3573020306920001

2013039206031 001

EDWARD FERNANDO

PESERTA

03/06/1992

RAMPAL CELAKET

373

0001809479193 3573021512750004

200610751215100100

ISWANTO

PESERTA

15/12/1975


374

0001809480712 3573024509770004

200610751215100100

diana fitri

ISTRI

05/09/1977


375

0001809482038 3573024612040001

200610751215100100

adellia tiara putri

ANAK

06/12/2004


376

0001809482927 3573027007110001

200610751215100100

alexandra kevina aurora putri

ANAK

30/07/2011


377

0001969128641 3573020303160001

200610751215100100

DAFFADEL MALIK RAKADITO

ANAK

03/03/2016


378

0001812707774 3311091808850001

ubr0065

DEWANTO PUTRA FAJAR

PESERTA

18/08/1985

M. YAZID, dr

379

0001812709181 3322184907860004

ubr0065

ANGGITA PERMANA PUTRI

ISTRI

09/07/1986

M. YAZID, dr

380

0001812710597 3311095104130001

ubr0065

ANNISA SALMA AZZAHRA

ANAK

11/04/2013

M. YAZID, dr

381

0001820329727 3573021706780005

2011067801710 01

EDY SATRIO HARTANTO

PESERTA

17/06/1978

M. YAZID, dr

1/31/17 4:02 PM

Page 22 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


382

0001299928026 3573024808790005

2011067801710 01

FRIDA PRETINA RINI

ISTRI

08/08/1979

M. YAZID, dr

383

0001322591321 3573024907080004

2011067801710 01

AUDREY REGINA ALIFSI

ANAK

09/07/2008

M. YAZID, dr

384

0001322592017 3573024512090003

2011067801710 01

DIANDRA BELVA KAMILIYA

ANAK

05/12/2009

M. YAZID, dr

385

0001822087383 3521051410840001

UBR0052

ANTOK WAHYU SEKTIONO, S.P., M.P.

PESERTA

14/10/1984

PANDANWANGI

386

0001822562886 3301172108870001

412

ANDI SETIAWAN,S.IP

PESERTA

21/08/1987

BATU

387

0001822569467 3375046505890004

412

MEILDA FITRIANA

ISTRI

25/05/1989

BATU

388

0002069958532 3375044305150001

412

AQEELA ANJANA ZUHDA SETIAWAN

ANAK

03/05/2015

BATU

389

0001823162613 3523151703860004

8603170411035 4

DANNY DWI SAPUTRA, SP. MSI PESERTA

17/03/1986

ADHANIAR A., dr

390

0000111155905 3573027001880003

8603170411035 4

RIKA RATNA SARI, sp. mp.

ISTRI

30/01/1988

KLINIK MELATI

391

0002217838678 3573015006150004

8603170411035 4

EMELIE TIARA ARNELITA

ANAK

10/06/2015

ADHANIAR A., dr

392

0001829539945 3573042801860002

2011078601281 001

EKO DWI SANTOSO

PESERTA

28/01/1986

MULYOREJO

393

0001830638902 3507285705850001

2014048505172 001

DIAN VIVIEN SETYAWATI

PESERTA

17/05/1985

KASEMBON

394

0001830635695 3578162906780010

2014048505172 001

ARIF DWI YUNIVAN

SUAMI

29/06/1978

KASEMBON

395

0001830641286 3507284410100001

2014048505172 001

NABILA PRICHA OKTAVIANANDA

ANAK

04/10/2010

KASEMBON

396

0001831810599 3573044206750005

2008027506022 001

WINARTI

PESERTA

02/06/1975

KLINIK RAWAT JALAN RAMPAL (AD)

397

0001831810127 3573020312730009

2008027506022 001

CAHYO NURANGKOSO

SUAMI

03/12/1973


398

0001831811714 3573051607140001

2008027506022 001

RAMADHAN ADI NUGROHO

ANAK

16/07/2014


1/31/17 4:02 PM

Page 23 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


399

0001840649455 3507116904870002

2012058704292 200

MAR'ATUN SHOLIKHAH

PESERTA

29/04/1987

DONOMULYO

400

0001842098635 3573055505840013

2008028405152 001

RIA LUVITA SARI

PESERTA

15/05/1984

MUNSIFAH Z, dr

401

0001842098275 3573012807810007

2008028405152 001

ANNAS KURNIA ILHAM

SUAMI

28/07/1981

MUNSIFAH Z, dr

402

0001842099039 3573050201140004

2008028405152 001

AGHA SATYA PUTRA ILHAM

ANAK

02/01/2014

MUNSIFAH Z, dr

403

0001846514608 3573055205860001

2010018605122 001

MEGA ANDRIAWATI

PESERTA

12/05/1986

DINOYO

404

0002218946668 3573054103150003

2010018605122 001

ANNISA HUMAIRA ADWA

ANAK

01/03/2015

DINOYO

405

0001846925864 3573045706830014

200603830617200100

TRI YUNIATIN

PESERTA

17/06/1983


406

0001846925392 3517031608830002

200603830617200100

AGUNG WICAKSONO

SUAMI

16/08/1983


407

0001850120864 3521100407880007

2012058807042 001

YULIANTO MUJI NUGROHO

PESERTA

04/07/1988

SHIERLY MARLENA, dr.

408

0001850121112 3575036308900003

2012058807042 001

MEGAWATI SISTIN AGUSTITA

ISTRI

23/08/1990


409

0002217521992 3575042608150001

2012058807042 001

DANISH AGHA NUGRAHA

ANAK

26/08/2015


410

0001852311014 3506196010890002

2014088910202 001

EFI PUSPITA SARI

PESERTA

20/10/1989


411

0001856065937 3573022105800008

0002301201706

SUKMA PATRYA, ST

PESERTA

21/05/1980


412

0001856084218 3573025409790001

0002301201706

ANITA SETYAWATI, ST

ISTRI

14/09/1979


413

0001856260078 3573021911090001

0002301201706

MUHAMMAD RASYAD ALAKBAR

ANAK

19/11/2009


414

0001856260416 3573025610130002

0002301201706

FATHYA NISA

ANAK

16/10/2013


415

0001859242779 3525150508860002

UBR004

EKO SAKTI PRAMUKANTORO

PESERTA

05/08/1986


416

0001468844199 3573054803890004

UBR004

CITRAWATI FITRI K.

ISTRI

08/03/1989

KENDALSARI

417

0001860203417 3507303006910001

2014069106301 001

NEO EKA CANDRA

PESERTA

30/06/1991


1/31/17 4:02 PM

Page 24 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


418

0001540664245 3514084506910001

2014069106301 001

JUNI WIDYASTUTIK

ISTRI

05/06/1991

PURWOSARI

419

0001861731538 3573054210860008

2012088610022 201

DINA OKTAVIA MARIANA

PESERTA

02/10/1986


420

0001866982871 3571014707890004

2012058907072 001

YONA DAYANINGSIH

PESERTA

07/07/1989


421

0001867054803 3507230112870001

2013088712011 001

BAYU SAPUTRO

PESERTA

01/12/1987

KARANG PLOSO

422

0001869283348 3573040801850002

feb007

AVIAN ACHADI

PESERTA

08/01/1985

BP WIRA HUSADA (AD)

423

0001871392937 3573031804810008

2006038104181 001

RIDWAN

PESERTA

18/04/1981

PANDANWANGI

424

0001871393332 3573036803850004

2006038104181 001

REFINA ANDRIANI

ISTRI

28/03/1985

PANDANWANGI

425

0001871393613 3573036311060007

2006038104181 001

DAREL RASYA SAPUTRA

ANAK

23/11/2006

PANDANWANGI

426

0001873425587 3573055808870002

0002301201705

AGUSTINA RAHAYU

PESERTA

18/08/1987


427

0001873574324 3573020608840001

2013098408062 100

WAHYU WIJANARKO, ST

PESERTA

06/08/1984


428

0001873575303 3573036203900003

2013098408062 100

ima senia anwar

ISTRI

12/03/1990


429

0002217677354 3573031311150002

2013098408062 100

MUHAMMAD ARSYAD WIJANARKO

ANAK

13/11/2015


430

0001874400884 3573052411850006

2012058511241 001

ANDI MOCH. MAWARDI, ST

PESERTA

24/11/1985


431

0001874402019 3510095409890005

2012058511241 001

atik rahmawati

ISTRI

14/09/1989


432

0002033459313 3573054803160001

2012058511241 001

andi fatimah az zahra

ANAK

08/03/2016


433

0001876615795 3573044501890005

2012010117001 55

DEVI CHOSTANTI

PESERTA

05/01/1989


434

0001876714154 3507246311910003

2014059111232 001

SUPRIATIN

PESERTA

23/11/1991

SINGOSARI

1/31/17 4:02 PM

Page 25 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


435

0001876952248 3572036211810002

2010018111222 001

FANI DIANA RATIKA

PESERTA

22/11/1981


436

0001471836723 3573021709800003

2010018111222 001

DARMAWAN WARTO NUGROHO

SUAMI

17/09/1980


437

0001876953677 3573025103110005

2010018111222 001

RAHMANIAR LINTANG NAWANGSASI

ANAK

11/03/2012


438

0001881673334 3507106309790003

7909231322032 9

HELLY NURUL KARIMA

PESERTA

23/09/1979

dr. SUHARTATIK (JST)

439

0001882402154 3507220509860001

2012058609051 01

ANINDITYA NUGROHO

PESERTA

05/09/1986

dr. IDA BAGUS DIKSANANDA (JST)

440

0002218467183 3507225110160001

2012058609051 01

hana nisaa'ul zahidah

ANAK

11/10/2016


441

0001886844767 3507216706810003

2012088106272 201

HARIYATUL FITRIA

PESERTA

27/06/1981

AGUNG TRISNO, dr

442

0001887777562 3573021110720007

2010087210111 001

MOKHAMAD AMRULLAH

PESERTA

11/10/1972

ARJUNO

443

0001889230689 3573050412860007

2013048612041 001

TAUFIK AKBAR AL FAJRI

PESERTA

04/12/1986


444

0001889231332 3515085709860006

2013048612041 001

trisna andarwulan

ISTRI

17/09/1986


445

0002216777433 3573054601160005

2013048612041 001

QYARA AYUDIA FARINA

ANAK

06/01/2016


446

0001893736225 3507196801890002

2011108901282 001

DIAH MIFTACHUL NIGNTYAS

PESERTA

28/01/1989


447

0001894438089 3573057112870002

2012058712312 001

AMINATUS SUHRIYAH

PESERTA

31/12/1987

Klinik Hamid Rusdi

448

0001213033432 3175042006810006

2012058712312 001

ABDUSSAFI

SUAMI

20/06/1981

Klinik Hamid Rusdi

449

0001894521216 3573021405780006

2008127805141 01

WIJANARKO

PESERTA

14/05/1978

Klinik Hamid Rusdi

450

0001894521802 3573026011880004

2008127805141 01

ayu retnoasih

ISTRI

20/11/1988

Klinik Hamid Rusdi

1/31/17 4:02 PM

Page 26 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


451

0001895723076 3579030806830001

8306081321012 0

ROH SANTOSO

PESERTA

08/06/1983

dr. SACHARIANO

452

0001898386547 3571014504910004

2011089104052 001

VITA SULININGTYAS

PESERTA

05/04/1991

TEGAR FADELI, DR

453

0001901056612 3504066609880002

2012058809262 001

SEPTIAN ERA YUSINDRA

PESERTA

26/09/1988


454

0001901055857 3573050302910002

2012058809262 001

AKHMAD NUR BUKHORI

SUAMI

03/02/1991


455

0002047175098 3573055904160002

2012058809262 001

ZEEFA NAFI AQILA AKHRA

ANAK

19/04/2016


456

0001904321158 3573012908820003

2014048208292 100

VIRGA MULA RANTAU

PESERTA

29/08/1982

Puskesmas BERSALIN PEMKOT

457

0001904322666 3573014605840014

2014048208292 100

TINA RISTIANA

ISTRI

06/05/1984


458

0001904324308 3573011503090004

2014048208292 100

M AVICHO ATALLA RAIHAN

ANAK

15/03/2009


459

0001904325243 3573015610130002

2014048208292 100

NAYLA AQUINNA

ANAK

16/10/2013


460

0001904343401 3573020703830002

2008038303070 01

JOKO SUMAHDIAWAN

PESERTA

07/03/1983

BARENG

461

0001904343906 3573026703840014

2008038303070 01

paramita kusuma r

ISTRI

27/03/1984

BARENG

462

0001904344773 3573020811090001

2008038303070 01

azzam rafi maulana s

ANAK

08/11/2009

BARENG

463

0001904345965 3573036706140001

2008038303070 01

azkia raisha maheswari s

ANAK

27/06/2014

BARENG

464

0001905117276 3573032202750006

2004047502221 001

LAZARUS WIDYO PRASETYO

PESERTA

22/02/1975

GRIBIG

465

0001905118413 3573036810810006

2004047502221 001

RISTA SUDI HARTATI

ISTRI

28/10/1981

GRIBIG

466

0001905119403 3573030503090001

2004047502221 001

HIZKIA YORISTIANTA

ANAK

05/03/2009

GRIBIG

1/31/17 4:02 PM

Page 27 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


467

0001905120966 3573030810120003

2004047502221 001

ALFREDO YORISTIANTA

ANAK

08/10/2012

GRIBIG

468

0001961531594 3517170909860001

ubr0059

LUTFI AMIRUDDIN

PESERTA

09/09/1986


469

0001961531976 3573024404830001

ubr0059

APRILIA TRIAS WAHYUNI

ISTRI

04/04/1983


470

0002039580022 3573021108070563

ubr0059

pradita dipantara amiruddin

ANAK

23/02/2016


471

0001963761489 3573021907740003

UBR001

ISMIARTA AKNURANDA

PESERTA

19/07/1974


472

0001963761579 3573025608780011

UBR001

IRMA ALIANTI

ISTRI

16/08/1978


473

0001963762132 3573012410820008

UBr002

BARLIAN HENRYRANU PRASETIO

PESERTA

24/10/1982


474

0000111900598 3573056606910002

UBr002

EDITA ROSANA WIDASARI

ISTRI

26/06/1991


475

0001963762503 3579031909840002

UBR003

ASWIN SUHARSONO

PESERTA

19/09/1984


476

0001963762615 3573016803900007

UBR003

AMELIA FARADINA

ISTRI

28/03/1990


477

0001963763324 3524091907850001

UBR005

IMAM CHOLISSODIN

PESERTA

05/08/1986


478

0001963766373 3573050404820020

ubr006

WIBISONO SUKMO WARDHONO

PESERTA

04/04/1982


479

0001963767238 3573054204489003

ubr006

BAYU KRISNA WARDANI

ISTRI

28/07/1989


480

0001963767306 3573055401140002

ubr006

mutiara kamaratih nusantari

ANAK

14/01/2014


481

0001963766992 3573041108830009

ubr0023

ibnu sam widodo

PESERTA

11/08/1983

DINOYO

482

0001963767093 3573034205830008

ubr0023

ade laressa

ISTRI

02/05/1983

DINOYO

483

0001963767183 3573044112130003

ubr0023

laisa farah laressa

ANAK

01/12/2013

DINOYO

484

0001963767971 3573045612800006

ubr0024

shanti riskawati

PESERTA

16/12/1980


485

0001963768296 3573054212830002

ubr0026

beauty suestining diyah d

PESERTA

02/12/1983


486

0001963768476 3573010903800005

ubr0026

lutfi ika wardhana

SUAMI

09/03/1980


487

0001963768588 3573054510090001

ubr0026

azka naazira wardhana

ANAK

05/10/2009


488

0001963769141 3517069509900006

ubr0027

riska septifani

PESERTA

25/09/1990


489

0000170731978 3517092003900003

ubr0027

DANANG TRI MASSANDY

ISTRI

20/03/1990


1/31/17 4:02 PM

Page 28 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


490

0001963772032 3507226806860001

ubr0029

elok waziiroh

PESERTA

28/06/1986


491

0001963772076 3507223005860001

ubr0029

dapin narendra

SUAMI

30/05/1986


492

0001963772335 3525011601800001

UBR009

mohamad anas

PESERTA

16/01/1980


493

0001963772379 3525166503820002

UBR009

MAULINA HIDAYATI

ISTRI

25/03/1982


494

0001963772436 3525161504110005

UBR009

AQIEL KAIS AD DAKHIEL

ANAK

15/04/2011


495

0002042619423 3573040703160001

UBR009

avicenna ahmad alrayees

ANAK

07/03/2016


496

0001963772919 3523120605850001

UBR0011

KHALID RAHMAN

PESERTA

06/05/1985

REJEKININGDIAH, dr

497

0001963772976 3507197003860001

UBR0011

AINATUL MARDHIYAH

ISTRI

30/03/1986

REJEKININGDIAH, dr

498

0001963773088 3507192007120002

UBR0011

AHMAD SHIDQI ZAIRUL MULTAZAM

ANAK

20/07/2012

REJEKININGDIAH, dr

499

0001963773112 3507196007120001

UBR0011

zakiya shafa zairul multazam

ANAK

20/07/2012

REJEKININGDIAH, dr

500

0001963773369 3507095503860001

ubr0012

galieh damayanti

PESERTA

15/03/1986


501

0001963773382 3507090701860002

ubr0012

bayu firmanda

SUAMI

07/01/1986


502

0001963779219 3526165109850001

UBR0013

nailah firdausiyah

PESERTA

11/09/1985


503

0001963779322 3174041501850010

UBR0013

moeh zaenal arifin

SUAMI

15/01/1985


504

0001963779592 3573017008120002

UBR0013

ziyan rumaisha arifin

ANAK

30/08/2012


505

0001963780391 3519110507840001

UBR0014

ming narto wijaya

PESERTA

05/07/1984


506

0001963781019 3578015311840001

ubr0031

vivien fathuroya

PESERTA

13/11/1984


507

0001963781289 3573055112870002

ubr0032

dina wahyu indriani

PESERTA

11/12/1987


508

0001964098708 3578231311870002

UBR0055

RISKI ARYA PRADIKTA

PESERTA

13/11/1987


509

0001964103118 3510166108860001

UBR0056

DRH. AJENG PESERTA AEKANURMANINGDYAH M.SC

21/08/1986


510

0001964110296 3515184305890006

UBR0057

NUPRIMADITA ROSENDIANI

PESERTA

03/05/1989


511

0001964112557 3578222309840001

UBR0058

I DEWA PUTU ANOM ADNYANA PESERTA

23/09/1984


512

0002082116428 3573010401060004

UBR0058

i dewa putu arya gayatri dharma

ANAK

30/08/2016


513

0001964114831 3524091202850005

ubr0033

MIFTAKHURRIZAL

PESERTA

12/02/1985


1/31/17 4:02 PM

Page 29 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


KURNIAWAN 514

0001964125956 3524094405860001

ubr0033

swesty mey wulansari

ISTRI

04/05/1986


515

0001964126384 3524091210130001

ubr0033

M IRZA DANISH EL FIKRI

ANAK

12/10/2013


516

0001964119397 3175055812860001

ubr0034

shinta rosalia dewi

PESERTA

18/12/1986


517

0001964122277 3509215011840004

ubr0053

NOVI HARYATI

PESERTA

10/11/1984


518

0001964123122 3573046409840003

ubr0035

SUDARMA DITA WIJAYANTI

PESERTA

24/09/1984


519

0001964124753 3573046409840006

ubr0035

yohanes budi

SUAMI

31/05/1978


520

0001964124696 3507224608750002

UBR0054

IVA DEWI LESTARININGSIH

PESERTA

06/08/1975


521

0001964128713 3271054802820023

ubr0036

IKA ATSARI DEWI

PESERTA

08/02/1982


522

0002059118019 3573015505160001

ubr0036

LATHIFAH ALISHA DIRA

ANAK

15/05/2016

MOJOLANGU

523

0001964132504 3573024505800004

UBR0037

SAKUNDA ANGGARINI

PESERTA

05/05/1980


524

0001964135272 3573032007850004

UBR0038

MOCHAMAD MURCHOLIS

PESERTA

20/07/1985


525

0001964135924 3573045810830002

UBR0038

FERONIKA HEPPY SRIHERFYNA

ISTRI

18/10/1983


526

0001964186572 3577024910860002

UBR0039

IKE ARNI NOVENTI

PESERTA

09/10/1986


527

0001964197203 3509026203860003

UBR0041

ANITA TRI WIDIYAWATI

PESERTA

22/03/1986


528

0001964197462 3507221508830002

UBR0041

ANDIKA HIJRAH PRASETYO

SUAMI

15/08/1983


529

0001964198283 3507221408140001

UBR0041

AZKA HAKIM DANISHSYAHM

ANAK

14/08/2014


530

0001964199969 3505041604810003

ub0016

JOHANNES PARLINDUNGAN

PESERTA

16/04/1981


531

0001964200375 3505044411800002

ub0016

ALBERTHIN YUDIANNOVA

ISTRI

04/11/1980


532

0001964202873 3507235902840001

ubr0017

KARTIKA EKA SARI

PESERTA

19/02/1984


533

0001964203244 3507240102850001

ubr0017

BACHTIAR ABDI IRAWAN HAKIM

SUAMI

01/02/1985


534

0001964203536 3507235208130001

ubr0017

SARAH SYAKIRAH AZZAHRAH ANAK

12/08/2013


535

0002042728705 3507230105130006

ubr0017

CALON BY NY. KARTIKA EKA SARI

08/03/2016

KLINIK YONKES 2/K

1/31/17 4:02 PM

ANAK

Page 30 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


536

0001964206113 3573011307860009

UBR0042

AULIA LUQMAN AZIZ

PESERTA

13/07/1986


537

0001964206517 3527030112840010

ubr0018

CHAIRUL MAULIDI

PESERTA

01/12/1984


538

0001964208701 3506177105870002

UBR0043

EDLYN KHUROTUL AINI

PESERTA

31/05/1987


539

0001964209904 5271014706880003

ubr0019

WULAN DWI PURNAMA SARI

PESERTA

07/06/1988


540

0001964213717 3519115111880001

UBR0044

NURLITA SUKMA ALFANDIA

PESERTA

11/11/1988


541

0001964216632 3518072901830001

UBR0045

NURJATI WIDODO

PESERTA

29/01/1983


542

0001313859993 3518076605870003

UBR0045

FITRI HANDAYANI

ISTRI

26/05/1987

KLINIK PUSDIK ARHANUD

543

0001383581158 3518075007140002

UBR0045

ALMIRA ZAFIRAH WIDODO

ANAK

10/07/2014


544

0001964216665 3508182711860002

ubr0020

KHAIRUL ANAM

PESERTA

27/11/1986


545

0001964218329 3507186408890002

ubr0021

ERYANI NURMA YULITA

PESERTA

24/08/1989


546

0001964237242 3573056112810001

ubr0060

afia fitriani

PESERTA

21/12/1981


547

0001964241707 3515131412850010

UBR0047

rendra eko wismanu

PESERTA

14/12/1985

SRI HAYATI, dr

548

0001964242416 3573015409880002

UBR0047

ARNIS TRI WIDIYATI

ISTRI

14/09/1988

SRI HAYATI, dr

549

0001964242304 3573051509880004

ubr0061

INDHAR WAHYU WIRA HARJO PESERTA

15/09/1986


550

0001964243981 3573044808880011

ubr0061

zwesty aridasarie

ISTRI

08/08/1986


551

0001964245476 3573051409800002

UBR0050

ARI DARMAWAN

PESERTA

14/09/1980


552

0001964247366 3573056307840008

ubr0062

dian putri permatasari

PESERTA

23/07/1984


553

0001964252259 3578315108840001

ubr0063

SRI HANDAYANI

PESERTA

11/08/1984


554

0001964254781 3573013112820001

ubr0048

ari riawan

PESERTA

31/12/1982


555

0001964259178 3573014106810002

ubr0048

solihat

ISTRI

01/06/1981


556

0001964259966 3573010909090010

ubr0048

hadziq maula dinillah

ANAK

09/09/2009


557

0001964260708 3573012204120003

ubr0048

azmi hisnul haq

ANAK

22/04/2012


558

0002054964914 3573010910090011

ubr0048

BY NY SOLIHAT

ANAK

26/04/2016


559

0001964264725 3603012104850001

ubr0046

andhyka muttaqin

PESERTA

21/04/1985


560

0001964266356 3603016905840003

ubr0046

nailul maromi

ISTRI

29/05/1984


1/31/17 4:02 PM

Page 31 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


561

0001964267741 3603010906090001

ubr0046

muhammad fathi thariq

ANAK

09/06/2009


562

0001964269067 3507221809100001

ubr0046

muhammad fathan adzim

ANAK

18/09/2010


563

0001964269721 3579036706120001

ubr0046

azky fathiya rahmi

ANAK

27/06/2012


564

0001964276662 3573014909830001

ubr0066

pantri muthriana erza k.

PESERTA

09/09/1983


565

0001964277483 3573011906830003

ubr0066

sangkala rahmat

SUAMI

19/06/1983


566

0001964282589 3573051509730001

ubr0067

dhanny septimawan sutopo

PESERTA

15/09/1973


567

0001964283658 3573055908730006

ubr0067

trias indra puspita

ISTRI

19/08/1973


568

0001964284795 3573050204030011

ubr0067

firaas zhaafirah s sutopo

ANAK

02/04/2003


569

0001964285234 3573055604080001

ubr0067

daanys qaanitah s sutopo

ANAK

16/04/2008


570

0001964287563 3573051810590002

ubr0068

mondry, sp ,m.sos

PESERTA

18/10/1959


571

0001964288518 3573055004680004

ubr0068

sumiana

ISTRI

10/04/1968


572

0001966612601 3573050607850002

2012028507001 001

AKHMAD MUKHTAROM

PESERTA

06/07/1985

KLINIK WIDYA HUSADA

573

0001969170772 3507235004890001

2008128904102 001

EMA ULFA SETYONINGRUM

PESERTA

10/04/1989


574

0001969164606 3507231709880002

2008128904102 001

FERY DIAN ANDRIAWAN

SUAMI

17/09/1988


575

0002048424489 3507235005160003

2008128904102 001

SAHILA ALDIFA PRAMESWARI ANAK

10/05/2016


576

0001971079571 3573052104760002

2011047604212 100

HERMANTO

PESERTA

21/04/1976


577

0001971081224 3573054908780004

2011047604212 100

KUSNUL KOTIMAH

ISTRI

09/08/1978


578

0001971082484 3573050909130003

2011047604212 100

ALBY NAUFAL PRADIPTA

ANAK

09/09/2013


579

0001971084723 3573050205150003

2011047604212 100

AZZAM FAHREZA AL GHIFARY ANAK

02/05/2015


580

0002033561913 3573055207820015

2014058207122 001

ISANA SETYANING DYAH

12/07/1982


1/31/17 4:02 PM

PESERTA

Page 32 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


581

0002033561327 3573051002820021

2014058207122 001

AULYA BAIHAQI

SUAMI

10/02/1982


582

0002063955677 3573052010080026

2014058207122 001

CALON BAYI NY. ISANA SETYANING DYAH

ANAK

08/06/2016


583

0002034115108 3514146509870001

2013048709252 001

INDAH AMALIAH AMRI

PESERTA

25/09/1987


584

0002034840701 3522151606860001

2008088606161 001

REZA BUDI FIRMANSYAH, S.AP.

PESERTA

16/06/1986

PUSKESMAS DAU

585

0002034842095 3507222204140002

2008088606161 001

muhammad nabil habibi

ANAK

22/04/2014

PUSKESMAS DAU

586

0002040404185 3507224605160001

2008088606161 001

adzkiya affa maritsa

ANAK

06/05/2016

PUSKESMAS DAU

587

0002034841566 3522156907850005

HUSNUL HIDAYAH

PESERTA

29/07/1985

PUSKESMAS DAU

588

0002038248797 3516105104920001

2011119204112 001

DAME P. AP. BR. MARPAUNG

PESERTA

11/04/1992

BANGSAL

589

0002040155032 3572024204870002

2010098704022 001

AYU ARDIANI

PESERTA

02/04/1987

dr. WASINGAH (JST)

590

0002043643443 3507234511830001

01

DWI SUSIANAH

PESERTA

05/11/1983

DINOYO

591

0002043645456 3507234412080003

01

ZULFA NABILA AISYA

ANAK

04/12/2008

DINOYO

592

0002044759094 3578025904890002

7865

RAIZA ALFA RAMADHIAN

PESERTA

19/04/1989

JUNREJO

593

0002044758813 3579032211870003

7865

ANDIK NOVIANTOK

SUAMI

22/11/1987

JUNREJO

594

0002082471827 3579031006160001

7865

ANDHRA ARSAKHA PANGESTU

ANAK

10/06/2016


595

0002057120144 3573012701890003

01

ACHMAD YANUAR AMIRUDIN

PESERTA

27/01/1989

PANDANWANGI

596

0001409396038 3573045409910005

01

NOVITA SEPTIANAWATI

ISTRI

14/09/1991

PANDANWANGI

597

0002061385828 3573012310820006

2010078210231 001

ASHE FIRMAN FAISHOL

PESERTA

23/10/1982

DINOYO

598

0002061386188 3573056205910002

2010078210231 001

IKA ANANDA PUJIASIH

ISTRI

22/05/1991

DINOYO

599

0002063727696 3518081211880003

2014058811121 001

ASWIN RIZAL NUR ROCHMAN

PESERTA

12/11/1988

UPIK MARIJATI,DR

1/31/17 4:02 PM

201009850729220010

Page 33 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


600

0002063729092 3506110507160001

2014058811121 001

muhammad adly nur iman

ANAK

05/07/2016

UPIK MARIJATI,DR

601

0002064075647 3507222702860001

2009038602271 001

ANIZAR AHMAD YASMIN

PESERTA

27/02/1986

PUSKESMAS DAU

602

0002064521171 3573025805810011

2010018105182 001

SUPRIANTI

PESERTA

18/05/1981


603

0002064521428 3573026208050002

2010018105182 001

NATHASYA AMALIA DEWAYANTI

ANAK

22/08/2005


604

0002064521575 3573022208110001

2010018105182 001

M.NAUFAL RAMADHAN

ANAK

22/08/2011


605

0002069098749 3573011309900002

feb015

YUSUF AFANDI

PESERTA

13/09/1990

CISADEA

606

0002070447423 3577034106900001

2014059006012 001

ARDANESWARI DYAH PITALOKA CITRARESMI, S.TP

PESERTA

01/06/1990

BP DKT KEDIRI

607

0002219765826 3508092407860002

2014059006012 001

AULIA ROCHMAN ISKANDAR

SUAMI

24/07/1986

BP DKT KEDIRI

608

0002072327872 3573036604840002

2013078404262 001

SUFFI KHUSTININGTYAS

PESERTA

26/04/1984

KEDUNG KANDANG

609

0002072328017 3573034106110003

2013078404262 001

CALISTA KHAIRINA ARDIANA

ANAK

01/06/2011

KEDUNG KANDANG

610

0002072858286 3573043012850003

2013028512301 001

ADITYA DEDY PURWITO, SE

PESERTA

30/12/1985

JANTI

611

0002073275278 3573022504850003

2010078504251 001

GABRIEL WAHYU PURNOMO,S.AP

PESERTA

25/04/1985

dr. IVA AULIA

612

0002073275695 3525105704910001

2010078504251 001

LIDWINA FARALINE TRIPRISILA

ISTRI

17/04/1991

dr. IVA AULIA

613

0002073275943 3573024412140002

2010078504251 001

ADELAIDE GRACEGEFA PURNOMO

ANAK

04/12/2014

dr. IVA AULIA

614

0002073700394 3573026210890002

2014058910222 01

ANGGRAENI OKTAVIA

PESERTA

22/10/1989

ARJUNO

615

0002073699314 3573021107880005

2014058910222 01

SANGGA CUMBUAN KEJORA

SUAMI

11/07/1988

ARJUNO

616

0002203300798 3573021508072579

2014058910222

CLN BY NY ANGGRAENI

ANAK

24/11/2016

ARJUNO

1/31/17 4:02 PM

Page 34 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

01

OKTAVIA

Hub. Keluarga


617

0002075889835 3517144407870001

2012088707042 001

YULIA SILVANI

PESERTA

04/07/1987


618

0002075889047 3517120709860001

2012088707042 001

MAKHRUS WAFIN

SUAMI

07/09/1986


619

0002081468024 3516130508840001

2011068509221 000

FERDIKA BAGUS PRISTIAWAN PESERTA PERMANA

05/08/1984


620

0002082236174 3522160711900002

2012079011071 001

WANDA AGUNG PRASETYO

PESERTA

07/11/1990

PURWOSARI

621

0002084956852 3507224603870001

0002084956852

AYU KUSUMASTUTI

PESERTA

06/03/1987

KENDALSARI

622

0002084956694 3578240402880001

0002084956852

KEN DIMAS YUDHA ASMARA

SUAMI

04/02/1988

KENDALSARI

623

0002084958156 3573052706160009

0002084956852

CLN BY NY AYU KUSUMASTUTI

ANAK

15/09/2016

KENDALSARI

624

0002093989285 3510097003830012

2013048303302 001

KHUSNUL MUNIKA LISTARI

PESERTA

30/03/1983


625

0002098759061 3507244101830052

2012058301012 001

UMI SALAMAH

PESERTA

01/01/1983

SINGOSARI

626

0002098759072 3507244212090004

2012058301012 001

TANISHA ZAFIRA NUR FADHILAH

ANAK

02/12/2009

SINGOSARI

627

0002098759083 3507240604060008

2012058301012 001

MUHAMMAD ZAKKY NUR ALFI ANAK

05/04/2006

SINGOSARI

628

0002198563942 3573056511840004

2011018411252 001

ALDILA NOVIATRI

PESERTA

25/11/1984


629

0002198563852 3573022403850005

2011018411252 001

PRIMA INANDIKA UTAMA PUTRA

SUAMI

24/03/1985


630

0002198564032 3573051310130003

2011018411252 001

DARREN ALEXEI ALINANDA

ANAK

13/10/2013


631

0002201733641 3507152303890001

2014038903231 001

BUDI SETIAWAN

PESERTA

23/03/1989

BULULAWANG

632

0002202399549 3507224207780002

003

DIAN CHANDRASASI

PESERTA

02/07/1978

dr. MARIA REGINA K (JST)

633

0002216556426 3515086307830004

2013048307232 001

DYAH PAWESTRI MAHARANIE PESERTA

23/07/1983

BUDURAN

1/31/17 4:02 PM

Page 35 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


634

0002216559879 3515150908810005

2013048307232 001

SUGIARTO,ST

SUAMI

09/08/1981

BUDURAN

635

0002216562963 3515152701100004

2013048307232 001

el valledria eiffelano

ANAK

27/01/2010

BUDURAN

636

0002216809359 3573042208800002

2007048008221 001

AGUS SUPRIONO

PESERTA

22/08/1980

CIPTOMULYO

637

0002216810305 3573044211890002

2007048008221 001

NOVI ARIN KUSUMA

ISTRI

02/11/1989

CIPTOMULYO

638

0002216811903 3573041705110005

2007048008221 001

AFRIZAL NABIL MAULANA

ANAK

17/05/2011

CIPTOMULYO

639

0002216825853 3507142509790001

2012057909251 001

SYAIRUL BUCHORI

PESERTA

25/09/1979

dr. ILYUSI

640

0002216828046 3507146103880003

2012057909251 001

NURUL AINI

ISTRI

21/03/1988

dr. ILYUSI

641

0002216829969 3507141907100001

2012057909251 001

RAIHAN BINTANG SYAHPUTRA ANAK

19/07/2010

dr. ILYUSI

642

0002216843155 3573054312750004

2011047512032 00

AMALIAH SUNDARI

PESERTA

03/12/1975

REJEKININGDIAH, dr

643

0002216844257 1207022603760007

2011047512032 00

YULFI

SUAMI

26/03/1976

REJEKININGDIAH, dr

644

0002216844933 3573056306050001

2011047512032 00

DELIA SABRINA AZZAHRA

ANAK

23/06/2005

REJEKININGDIAH, dr

645

0002216845427 3573051612060001

2011047512032 00

FARHAN IBNU UMARI

ANAK

16/12/2006

REJEKININGDIAH, dr

646

0002216846204 3573052603140003

2011047512032 00

HUSEIN AKMAL LATHIF

ANAK

26/03/2014

REJEKININGDIAH, dr

647

0002217029231 3573024110750004

2012047510012 001

ESTER HANDAYANI LODRA

PESERTA

01/10/1975

ARJUNO

648

0002217032673 3573022805040001

2012047510012 001

jeremy steven christian

ANAK

28/05/2004

ARJUNO

649

0002217034012 3573027609060002

2012047510012 001

eunice sharon christian

ANAK

30/09/2006

ARJUNO

1/31/17 4:02 PM

Page 36 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


650

0002217035035 3573026212080006

2012047510012 001

angeline shenny christian

ANAK

22/12/2008

ARJUNO

651

0002217326556 3573021005710007

2011097105101 001

ALOYSIUS PRANAWA ARISJWARUPANANDA

PESERTA

10/05/1971

ARJUNO

652

0002217328413 3576015001790002

2011097105101 001

IKA ERISA WIJAYANTI

ISTRI

10/01/1979

ARJUNO

653

0002217329853 3576015801040004

2011097105101 001

MARGARETA FRANSISKA C.O. ANAK

18/01/2004

ARJUNO

654

0002217411639 3517091304830009

2006118304131 001

ADITYA MAHARI

PESERTA

13/04/1983

JELAKOMBO

655

0002217412078 3517095008830004

2006118304131 001

NOR FITA FITRIA

ISTRI

10/08/1983

JELAKOMBO

656

0002217412449 3517090902100001

2006118304131 001

BINTANG ABDILLAH

ANAK

09/02/2010

JELAKOMBO

657

0002217414284 3517096702140001

2006118304131 001

bening saskirana

ANAK

27/02/2014

JELAKOMBO

658

0002217433083 3578141802820003

2010078202181 001

AGUS HERWANTO

PESERTA

18/02/1982


659

0002217440237 3514132503880001

2012058803251 001

LUTFI SAIFI

PESERTA

25/03/1988

WAHYU WIDYA ASMARA, dr.

660

0002217441194 3507227107750001

2012087507312 001

MERLYA BALBEID, DRG.

PESERTA

31/07/1975

KENDAL KEREP

661

0002217441587 3573010806700009

2012087507312 001

ABDUL AZIZ BA'ABDULLAH

SUAMI

08/06/1970

KENDAL KEREP

662

0002217443128 3507222301990001

2012087507312 001

MUHAMMAD ZAYYAN

ANAK

23/01/1999

KENDAL KEREP

663

0002217444423 3507226907020001

2012087507312 001

SANINAH

ANAK

29/07/2002

KENDAL KEREP

664

0002217444873 3507220802060001

2012087507312 001

DANIYAL BA'ABDULLAH

ANAK

08/02/2006

KENDAL KEREP

665

0002217445007 3573054907860007

2010078607692 001

DYAHGUNITA PARAMITA PUTRI

PESERTA

09/07/1986

ARJOWINANGUN

1/31/17 4:02 PM

Page 37 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


666

0002217445929 3573011309850007

2010078607692 001

RICO ANGGRAHAN

SUAMI

13/09/1985

ARJOWINANGUN

667

0002217448416 3516065702820004

2014058202172 001

RATIH PUSPORINI

PESERTA

17/02/1982

KENDAL KEREP

668

0002217448585 3573040605820003

2014058202172 001

ANDREAS DWI WICAKSONO

SUAMI

06/05/1982

KENDAL KEREP

669

0002217449013 3573046704120002

2014058202172 001

AKSARA MERAH MEWANGI

ANAK

27/04/2012

KENDAL KEREP

670

0002217449845 3507142502660002

2010036602251 001

SUKARDI

PESERTA

25/02/1966

BULULAWANG

671

0002217451037 3573036405680001

2100368052420 01

M.V TRINING WIDODORINI

PESERTA

24/05/1968

KEDUNG KANDANG

672

0002217451151 3573030306670007

2100368052420 01

J.J WAHJU BIMOKO

SUAMI

03/06/1967

KEDUNG KANDANG

673

0002217462489 3507225111880006

2012088811111 001

LILA WIJAYA

PESERTA

11/11/1988

PUSKESMAS DAU

674

0002217462838 3507226009120002

2012088811111 001

GARCINIA MIKAELA AIRIN

ANAK

20/09/2012

PUSKESMAS DAU

675

0002217462939 3507226112150001

2012088811111 001

ADEEVA AFSHEEN WIJAYA

ANAK

21/12/2015

PUSKESMAS DAU

676

0002217469206 3507250108860002

2010018608011 001

MUCHAMMAD RIKHI TOUFAN

PESERTA

01/08/1986

KLINIK ELISA

677

0002217469509 3573054906770001

2010047706092 001

KARTINI

PESERTA

09/06/1977

DINOYO

678

0002217470253 3671012708770003

2008067708271 001

ZAINAL MUSTOFA AHMAD

PESERTA

27/08/1977


679

0002217470398 3501115409800007

2008067708271 001

YENI DWI ASTARI

ISTRI

14/09/1980


680

0002217470488 3573031312140003

2008067708271 001

KEENAN ATHARIZZY ZAIN

ANAK

13/12/2014


681

0002217471794 3573051908800003

2011028008191 001

BIRRUL WALIDAINI, SP

PESERTA

19/08/1980

REJEKININGDIAH, dr

1/31/17 4:02 PM

Page 38 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


682

0002217471884 3573055005870003

2011028008191 001

WELI YATI

ISTRI

10/05/1987

REJEKININGDIAH, dr

683

0002217472018 3573056501110006

2011028008191 001

NAILA ATIQA WALIDAINI

ANAK

25/01/2011

REJEKININGDIAH, dr

684

0002217472097 3573052408130003

2011028008191 001

MOHAMMAD ALBY GHIFARI WALIDAINI

ANAK

24/08/2013

REJEKININGDIAH, dr

685

0002217473425 3507146603810001

2009088103262 001

HESTY FARMAWATI

PESERTA

26/03/1981

dr. ILYUSI

686

0002217475056 3507231609860001

2012058609161 001

HAPPY ARFIYANTO

PESERTA

16/09/1986


687

0002217475618 3573044102950005

2012058609161 001

LULUH HABIBILLAH

ISTRI

01/02/1995


688

0002217475776 3507236101140001

2012058609161 001

JIHAN LUPPY ZAKIYAH

ANAK

21/01/2014


689

0002217475956 3573021204820001

2010078204121 001

EDI SUNANDAR

PESERTA

12/04/1982

ARJUNO

690

0001336669896 3573026305820002

2010078204121 001

SUDARTIK

ISTRI

23/05/1982

ARJUNO

691

0002217476259 3573024607090002

2010078204121 001

AURIRA CANTIKA

ANAK

06/07/2009

ARJUNO

692

0002217476428 3573024312140001

2010078204121 001

SHAKILA AURAHMA

ANAK

03/12/2014

ARJUNO

693

0002217482763 3573050701820015

002

ARY DEDDY PUTRANTO, ST

PESERTA

07/01/1982


694

0002217482919 3573016106800005

002

UNI HAPSARI SISWANDINI

ISTRI

21/06/1980


695

0002217483009 3573016301120003

002

AZKANIA KIRANA DEWI MAHESWARI

ANAK

23/01/2012


696

0002217484664 3573055306840007

2011068406132 001

ITA TRIANA

PESERTA

13/06/1984

DINOYO

697

0002217484743 3518160606860006

2011068406132 001

ANDI EKO PRASETYO

SUAMI

06/06/1986

DINOYO

698

0002217484822 3573054703120002

2011068406132 001

CALLYTA RAIHANAH DZAKIYYAH

ANAK

07/03/2012

DINOYO

1/31/17 4:02 PM

Page 39 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


699

0002217484877 3573052608150001

2011068406132 001

HAFIZ NAUFAL ABBIYYU

ANAK

26/08/2015

DINOYO

700

0002217485136 3573035909820001

004

francisca gayuh utami dewi

PESERTA

19/09/1982


701

0002217485215 3573012205850004

004

dwi armanda st

SUAMI

22/05/1986


702

0002217485316 3573014304130003

004

almaira neishaputri afranda

ANAK

22/05/2013


703

0002217485788 3573010409810007

2014018109041 001

SLAMET HASAN

PESERTA

04/09/1981

KENDAL KEREP

704

0002217485812 3573014708080003

2014018109041 001

SYEILANIMAR RIZKY RAHMADANI

ANAK

07/08/2008

KENDAL KEREP

705

0002217485845 3573011103130002

2014018109041 001

SANDYTAMA RIZKY TRI HASANANTA

ANAK

11/03/2013

KENDAL KEREP

706

0002217485856 3507101810830002

006

IHWAN HAMDALA

PESERTA

18/10/1983

GONDANGLEGI

707

0002217485889 3579010405840003

2013098405041 001

FAHRON DAKKA

PESERTA

04/05/1984


708

0002217486262 5271052607870001

007

LALU TRI WIJAYA NATA KUSUMA

PESERTA

26/07/1987


709

0002217486317 3573025005880001

007

AMAYLIA FITRIA DEWI

ISTRI

10/05/1988


710

0002217486363 3573041102150003

007

LALU RADITYA ALTHAFANDRA ANAK KUSUMA

11/02/2015


711

0002217486295 3573052008840010

5674

YOGA PRABOWO SANYOTO

20/08/1984


712

0002217486374 3573046405830007

5674

ANDHIKA HIRASMA TITRIS MEI ISTRI RAHAYU

24/05/1983


713

0002217486396 3573042201120001

5674

ATHAYA MOISSANI MANGGALA

ANAK

22/01/2012


714

0002217486429 3573041305140005

5674

ABID PRANAJA

ANAK

13/05/2014


715

0002217487015 3578090303820003

008

RAKHMAT HIMAWAN

PESERTA

03/03/1982


716

0002217487059 3578094706840006

008

VIA AULIANA, SSN, MDS

ISTRI

07/06/1984


717

0002217487094 3578090310110004

008

RAHMAN PARSA ILAFI

ANAK

03/10/2011


718

0002217487713 3573014405870002

001

WASISKA IYATI

PESERTA

04/05/1987

KENDAL KEREP

1/31/17 4:02 PM

PESERTA

Page 40 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


719

0002217487746 3216060606860013

001

MOCHAMAD MUZAKI

SUAMI

06/06/1986

KENDAL KEREP

720

0002217538923 3515186708840010

2013048408272 001

VIRANDA SUTANTI

PESERTA

27/08/1984

WARU

721

0002217582472 3514142508870001

2010118708251 001

WAHYU RIZALDY

PESERTA

25/08/1987

M. YAZID, dr

722

0000110368811 3573025402890003

2010118708251 001

INDAH AYU WARDHANI

ISTRI

14/02/1989

M. YAZID, dr

723

0002217634558 3573052211870001

2011078711221 001

HERU PRASETYO

PESERTA

22/11/1987

KLINIK TELEMEDIKA HEALTH C.

724

0002217652255 3573011606660006

200810660616100100

SAIFUL BAKHRI

PESERTA

16/06/1966

CISADEA

725

0002217652749 3573016211710003

200810660616100100

SUPIJAH

ISTRI

22/11/1971

CISADEA

726

0002217653166 3573010503020007

200810660616100100

MUHAMMAD RAFLY MUMTAZ

ANAK

05/03/2002

CISADEA

727

0002217653572 3573017112030001

200810660616100100

HANA ROSITA BAKHRI

ANAK

31/12/2003

CISADEA

728

0002217659657 3573047005870005

2013018705302 200

YUSTI DIAN FITRIANA

PESERTA

30/05/1987


729

0002217662425 3507185105130002

2013018705302 200

AYDIN BAHIRA RACHMADIAN

ANAK

11/05/2013


730

0002217662008 3507131011750001

201107511101001000

MUH HASAN MUHAJIR

PESERTA

10/11/1975

KEPANJEN

731

0002217662302 3507136105810004

201107511101001000

JUMILAH

ISTRI

21/05/1981

KEPANJEN

732

0002217668073 3573052401840010

2013098401242 100

MOHAMMAD IRFAN EFENDI

PESERTA

24/01/1984

DINOYO

733

0002217668962 3573056908150003

2013098401242 100

SHAQILLA AZAHRA PUTRI EFENDI

ANAK

29/08/2015

DINOYO

734

0002217682462 3573050308790012

200904790803100100

DENI AGUS DARMAWAN

PESERTA

03/08/1979

DINOYO

735

0002218204721 3573055411840012

200904790803100100

MARIA ULFAH

ISTRI

14/11/1984

DINOYO

736

0002218205169 3573050801060001

200904790803100100

AHMAD ROZAN DZAKI MUBARAK

ANAK

08/01/2006

DINOYO

737

0002218205485 3573056701130002

200904790803100100

SYAKIRA LUBNA NISA

ANAK

27/01/2013

DINOYO

738

0002217846881 3511102306860001

23/06/1986


1/31/17 4:02 PM

2013088606231 001

MOCHAMMAD SYAMSUL HADI PESERTA

Page 41 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


739

0000112045746 3573054605850005

2013088606231 001

RISKIYAH

ISTRI

06/05/1985


740

0002217849467 3573052202150003

2013088606231 001

RASENDRIYYA SYADKIY QIBLAT

ANAK

22/02/2015


741

0002217848196 3573032406860002

000

ARIF BUDI PRASETYA

PESERTA

24/06/1986

KEDUNG KANDANG

742

0001636335437 3573054912880004

000

LAILY NURAIDA

ISTRI

09/12/1988


743

0002217853012 3573051903150001

000

AKHTAR PANDU PRASETYA

ANAK

19/03/2015

KEDUNG KANDANG

744

0002217851032 3577032608870003

2013048708261 001

MUHAMMAD AKHID SYIB'LI

PESERTA

26/08/1987


745

0002217852369 3204056309860005

2013048708261 001

ANA USWATUN HASANAH

ISTRI

23/09/1986


746

0002217852617 3577030702130003

2013048708261 001

MUKHLIS KHOIRUMAN TAZAKKA

ANAK

07/02/2013


747

0002217855611 3573050904870006

2014058704091 001

SATIVANDI RIZA,SP, MSC

PESERTA

09/04/1987

KLINIK MELATI

748

0000174048276 3514144510910002

2014058704091 001

GHUFRILLAH NAVRATILOVA

ISTRI

05/10/1991

KLINIK MELATI

749

0002217856364 3573051310150002

2014058704091 001

FERIO ADHYASTARIZA

ANAK

13/10/2015

KLINIK MELATI

750

0002217855903 3507221605860002

000

RABINDRA CAHYA PUTRA

PESERTA

16/05/1986

DINOYO

751

0001829053179 3507135704940003

000

AMALINA NURIN AWANIS

ISTRI

17/04/1994

KEPANJEN

752

0002217856781 3573010212770007

7712021321034 1

ANDY FIRMANSYAH

PESERTA

02/12/1977

Almira Medical Clinic

753

0002217857207 3507255204820004

2013118204121 001

haiqma subehan

PESERTA

12/04/1982

ARRY BUDIARTI, dr

754

0002217857332 3507245312830003

2013118204121 001

LULUK FAUZIAH

ISTRI

13/12/1983

ARRY BUDIARTI, dr

755

0002217857646 3507253005130001

2013118204121 001

BHISMA AIZAR PRADIPTA

ANAK

30/05/2013

ARRY BUDIARTI, dr

756

0002217859705 3579015012860001

2013048612102 001

SILVI IKAWATI

PESERTA

10/12/1986


1/31/17 4:02 PM

Page 42 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


757

0002217859929 3579031705870003

2013048612102 001

FERRY FERNANDA EKA SETYAWAN

SUAMI

17/05/1987


758

0002217860087 3579032903140001

2013048612102 001

NAUFAL NARA SETYAWAN

ANAK

29/03/2014


759

0002217860021 3573050610810001

2011128110061 001

SUWITO

PESERTA

06/10/1981

DINOYO

760

0002217860302 3573054601810004

2011128110061 001

MAULIDA INDRAWATI

ISTRI

06/01/1981

DINOYO

761

0002217860526 3573054612020002

2011128110061 001

SHINTYA AYU FITRIANI

ANAK

06/12/2002

DINOYO

762

0002218459285 3573052111100005

2011128110061 001

RANGGA PUTRA ARDIANSYAH ANAK

21/11/2010

DINOYO

763

0002217865408 3573024208870003

332

DEWA AYU PUTU EVA WISHANTI

PESERTA

02/08/1987


764

0002217867535 3573030906770002

2013117706091 001

DADANG NUR PRASETYO SUBEKTI

PESERTA

09/06/1977

KLINIK ELISA

765

0002217867761 3507196505820001

2013117706091 001

IDA RUSTIANI

ISTRI

25/05/1982

KLINIK ELISA

766

0002217867895 3507194102020005

2013117706091 001

FEBY NADIA PUTRI

ANAK

01/02/2002

KLINIK ELISA

767

0002217867996 3573030503140002

2013117706091 001

AFFAN RAKHMAN PRASETYO

ANAK

05/03/2014

KLINIK ELISA

768

0002217869425 6472035402860008

211

FIRSTYARINDA VALENTINA I

PESERTA

14/02/1986


769

0002217870369 3573046907840009

000

NURHIDAYATI YULIANDANI

PESERTA

29/07/1984


770

0002217876715 3573024503810002

000

SUHARSINAH

PESERTA

05/03/1981

BARENG

771

0002217876816 3573021205840004

000

BASYAR BUDY YUWONO EFENDY

SUAMI

12/05/1984

BARENG

772

0002217876884 3573025302070002

000

AIN NUR AZIZAH PUTRI HARSYA

ANAK

13/02/2007

BARENG

773

0002217876952 3573020808110003

000

ACHMAD DZANY RANGGA RAMADHAN

ANAK

08/08/2011

BARENG

1/31/17 4:02 PM

Page 43 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


774

0002217877907 3573045602880004

000

RATNA KARTIKA TUNGGA DEWI

PESERTA

16/02/1988


775

0002217878302 3573045304160003

000

CECILIA BELVANYA CHRISTA ADELIA

ANAK

13/04/2016


776

0002217879797 3507226903850002

000

NURINGSIH PERMANASARI

PESERTA

29/03/1985

PUSKESMAS DAU

777

0002217879876 3507221110840001

000

WILDAN AL FARIZI

SUAMI

11/10/1984

PUSKESMAS DAU

778

0002217879911 3507221808150001

000

FAZBILL ZHAFRAN ALFARIZI

ANAK

18/08/2015

PUSKESMAS DAU

779

0002217898078 3526041108720002

2010097208111 001

AGUS BUDI CAHYONO. SPD, M.LET

PESERTA

11/08/1972

DINOYO

780

0002217898348 3526044906760001

2010097208111 001

NUR INTAN KUMALA, SP

ISTRI

09/06/1976

DINOYO

781

0002217898899 3526044904060002

2010097208111 001

AIRUMI QONITAH SARI

ANAK

09/04/2006

DINOYO

782

0002217900374 3507281905720001

2007037205011 001

SUKARIJONO

PESERTA

19/05/1972

KASEMBON

783

0002217900644 3507285206820006

2007037205011 001

NILA KURNIAWATI

ISTRI

12/06/1982

KASEMBON

784

0002217900756 3507285312000001

2007037205011 001

YOLANDA ARMALIA R

ANAK

13/12/2000

KASEMBON

785

0002217901004 3507281301090001

2007037205011 001

REOVALDO YOLANTINO JANUAR

ANAK

13/01/2009

KASEMBON

786

0002217900464 3524091409860004

2012028609141 001

FARID AHMADI

PESERTA

14/09/1986

DINOYO

787

0002218937332 3513224308860001

2012028609141 001

SUPIATUN

ISTRI

03/08/1986

DINOYO

788

0002217903107 3507244805870001

2011048705082 001

ROMADLON MIFTAKHURRIZQI PESERTA

08/05/1987

SINGOSARI

789

0002217902343 3507240502870004

2011048705082 001

INDRA

SUAMI

05/02/1987

SINGOSARI

790

0002217903816 3507242410120008

2011048705082 001

ADEEVA INDRASTA HASTUNGKARA

ANAK

21/10/2012

SINGOSARI

1/31/17 4:02 PM

Page 44 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


791

0002217904492 3507246410120003

2011048705082 001

ANINDYA KYARA MAHESWARI ANAK

24/10/2012

SINGOSARI

792

0002217904738 1375026703860005

2013048603272 001

EKA MARTHANTY INDAH LESTARI, SS, M.SI

PESERTA

27/03/1986

ARJUNO

793

0002217904806 3507082411900002

2011029011241 001

ABDUR ROHMAN MUHAMMAD PESERTA

24/11/1990

WAJAK

794

0002217905842 3573051812800007

2012028012181 001

IWANTO

PESERTA

18/12/1980

DINOYO

795

0002217905921 3573054612840008

2012028012181 001

HAMIDAH

ISTRI

05/12/1984

DINOYO

796

0002217906033 3573052103060001

2012028012181 001

AHMAD ALKARIMI JAELANI

ANAK

21/03/2006

DINOYO

797

0002217906101 3573051502140005

2012028012181 001

AHMAD AFKAR HIDAYATULLOH

ANAK

15/02/2014

DINOYO

798

0002217906189 3507096806860003

2012018606282 002

NURUL LAILI N

PESERTA

28/06/1986

TUREN

799

0002217906202 3579012201810005

2011048101221 001

EKA JANUARD FIRDAUS

PESERTA

22/01/1981

BATU

800

0002217906325 3507226303860001

2011048101221 001

ENI MAYANTI

ISTRI

23/03/1986

BATU

801

0002217906382 3579015405130003

2011048101221 001

EVE GABRIELLA LATANZHA

ANAK

14/05/2013

BATU

802

0002217907552 3503116605820002

2016058205262 001

FEMI EKA RAHMAWATI

PESERTA

26/05/1982

PUSKESMAS DAU

803

0002217907866 3503112909820002

2016058205262 001

COKRO WIBOWO SUMARSONO

SUAMI

29/09/1982

PUSKESMAS DAU

804

0002217908057 3503111601100001

2016058205262 001

PANJI AGUNG NUSANTARA

ANAK

16/01/2010

PUSKESMAS DAU

805

0002217908171 3507180607880001

2011048807061 001

HENDRIK TRILAKSONO

PESERTA

06/07/1988

TAJINAN

806

0002217908711 3507155109140001

2011048807061 001

DIANDRA CHALYSTA NADIVA

ANAK

11/09/2014

TAJINAN

1/31/17 4:02 PM

Page 45 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


807

0002217909183 3507246405810004

8105240322069 3

KHATI NUR ISLAMI

PESERTA

24/05/1981

SINGOSARI

808

0002217909374 3507241111810002

8105240322069 3

NOVIAN WIJAYA

SUAMI

11/11/1981

SINGOSARI

809

0002217909688 3507246809070007

8105240322069 3

TABINA KEISHA WIJAYA

ANAK

28/09/2007

SINGOSARI

810

0002217909723 3507243012110006

8105240322069 3

DANENDRA CAESAR WIJAYA

ANAK

30/12/2011

SINGOSARI

811

0002217909655 3314120603860002

2012018603061 001

FREDY NUGROHO SETIAWAN PESERTA

06/03/1986

PUSKESMAS DAU

812

0002217910713 3314095004860003

2012018603061 001

PUTRI SARASWATI

ISTRI

10/04/1986

PUSKESMAS DAU

813

0002217911231 3507226804130002

2012018603061 001

rania sarastia nismara

ANAK

28/04/2013

PUSKESMAS DAU

814

0002217910487 3573030604880006

2013068804061 001

IBNU ADIANSYAH

PESERTA

06/04/1988

KEDUNG KANDANG

815

0002217910599 3507217004890002

2013068804061 001

ALISA FIDRIANTI

ISTRI

30/04/1989

KEDUNG KANDANG

816

0002217910937 3516083103890001

2011028903311 001

M. SYAMSUL ARIF HIDAYATTULLAH

PESERTA

31/03/1989

MOJOSARI

817

0002217911084 3573013001840011

8041300321031 8

WEMPI NAVIERA

PESERTA

30/01/1984

KENDAL KEREP

818

0002217911905 3573025312890002

2013068912132 100

DIAZ MUFIDA

PESERTA

13/12/1989


819

0002217912028 3575032906870001

2013068912132 100

GINANJAR INDRA KUSUMA NUGRAHA

SUAMI

29/06/1987


820

0002217911995 3507246203840001

2011048403222 200

RAHMI AMALIA

PESERTA

22/03/1984

SINGOSARI

821

0002217912816 3507242306110002

2011048403222 200

muhammad ukasya alfarezel

ANAK

23/06/2011

SINGOSARI

822

0002217912366 3507105212730011

2012017312122 001

ISWAHYUNI

PESERTA

12/12/1973

GONDANGLEGI

1/31/17 4:02 PM

Page 46 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


823

0002217912783 3507103009720002

2012017312122 001

DJOKO HERY SANTOSO

SUAMI

30/09/1972

GONDANGLEGI

824

0002217913075 3507106309090003

2012017312122 001

TALITA SALSABILA SANTOSO

ANAK

23/09/2009

GONDANGLEGI

825

0002217913435 3573016101840002

8401211322007 3

ANITA NURUL AINI

PESERTA

21/01/1984


826

0002217913503 3573010304790005

8401211322007 3

JOKO SUWARNO

SUAMI

03/04/1979


827

0002217913481 3573046306800008

201301800623

ELLYSABETH TRISNAWATI

PESERTA

23/06/1980

RAMPAL CELAKET

828

0002217914559 3573020406830004

201301800623

LUCIA YOPI SUSANTO

SUAMI

04/06/1983

RAMPAL CELAKET

829

0002217913604 3573021510130002

201301800623

LU CIA ISHAQ AL ADHA

ANAK

15/10/2013

RAMPAL CELAKET

830

0002217914605 3573024711150004

201301800623

LUCIA AZALEA ZELINE

ANAK

07/11/2015

RAMPAL CELAKET

831

0002217913874 3573042003770004

2004077703201 001

SRI UTOMO

PESERTA

20/03/1977

JANTI

832

0002217914133 3504134408840002

2010078408042 001

SITI KUMALASARI CAHYANINGSIH

PESERTA

04/08/1984

MULYOREJO

833

0002217914818 3573054503780007

7803051022036 6

ELISA INDARTI

PESERTA

05/03/1978

DINOYO

834

0002217915044 3573052103780006

7803051022036 6

KHOIRUL ANWAR

SUAMI

21/03/1978

DINOYO

835

0002217915099 3573050610060001

7803051022036 6

ARYA SYIFA ATHAILLAH

ANAK

06/10/2006

DINOYO

836

0002217915156 3573056011150005

7803051022036 6

CARISSA SAVINA LARASATI

ANAK

20/11/2015

DINOYO

837

0002217915066 3573050808810018

2013028108081 001

SULIS SISWANTO

PESERTA

04/05/1980


838

0001717293914 3507225501670002

2013028108081 001

PUDYASTUTI

ISTRI

15/01/1967


839

0002217915404 3507332409840002

2012018402410 01

MOH HASBULLAH ISNAINI

PESERTA

24/09/1984

PAGELARAN

840

0002217915505 3507222203830001

2013058303221 001

ARIF BUDI SETIYONO

PESERTA

22/03/1983

PUSKESMAS DAU

1/31/17 4:02 PM

Page 47 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


841

0002217915606 3505035205890003

2013058303221 001

LAILATUL FITRIANA

ISTRI

12/05/1989

PUSKESMAS DAU

842

0002217915641 3507225902140002

2013058303221 001

SYIFA ZAFIRA MAHESTRI

ANAK

19/02/2014

PUSKESMAS DAU

843

0002217915731 3573042407800010

2011078007241 001

KARTONO ANGKAT PRIBADI

PESERTA

24/07/1980

JANTI

844

0002217916034 3573045103790007

2011078007241 001

ERNI ROFITA

ISTRI

11/03/1979

JANTI

845

0002217916091 3573040904050005

2011078007241 001

RIFKY AMALI

ANAK

09/04/2005

JANTI

846

0002217916168 3573046511090005

2011078007241 001

ARILLA IRMALIYA

ANAK

25/11/2009

JANTI

847

0002217915966 3318200910850003

2013048510091 001

MUHAMMAD ROZIN

PESERTA

09/10/1985

PANDANWANGI

848

0000102346492 3578056601920001

2013048510091 001

DINDYAH SISCA PRAHENTI

ISTRI

26/01/1992

PANDANWANGI

849

0002217916596 3573011205160003

2013048510091 001

EKSA REYNAND HESTAMMA

ANAK

12/05/2016

PANDANWANGI

850

0002217916045 3508070807840002

2010078407081 001

ARDHIAN ARIK KURNIANTO

PESERTA

08/07/1984

YOSOWILANGUN

851

0002217916552 3573054508810009

2011038108052 001

LAILA FITRIYA

PESERTA

05/08/1981

DINOYO

852

0002217917158 3573052906080003

2011038108052 001

RANDY DIAZ KUSUMA

ANAK

29/06/2008

DINOYO

853

0002217917248 3573056411150002

2011038108052 001

RANY KARISMA DEWI

ANAK

24/11/2015

DINOYO

854

0002217917182 3507224504720002

2008107204052 001

LULUK FARIDAH

PESERTA

05/04/1972

JUNREJO

855

0002217918025 3507222810840001

8410281021036 3

LUQMAN KAMIM

PESERTA

28/10/1984


856

0002217920984 3573050802870003

2008128702081 001

LUKMAN HADI WIJAYA

PESERTA

08/02/1987

KARANG PLOSO

1/31/17 4:02 PM

Page 48 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


857

0002217921568 3573032405840002

2009078452410 01

ROCHMAT HIDAYAT

PESERTA

24/05/1984

KEDUNG KANDANG

858

0002217922086 3573050212850006

2004118512021 001

YEFRI MAULUTDIN

PESERTA

02/12/1985

MOJOLANGU

859

0002217922593 3507226201860004

2010068601222 001

LINTANG AYU RENGGANINGRUM

PESERTA

22/01/1986

PUSKESMAS DAU

860

0002217922874 3515152310850002

2010068601222 001

DHARMA MUJIADI SUBIYAKTO SUAMI

23/10/1985

PUSKESMAS DAU

861

0002217922931 3507224212090001

2010068601222 001

KANAYA NADHIFA SHAKUNTALA

ANAK

02/12/2009

PUSKESMAS DAU

862

0002217923019 3507224707120001

2010068601222 001

CLARINTA BENING ARRAHMI

ANAK

07/07/2012

PUSKESMAS DAU

863

0002217923379 3507220308140002

2010068601222 001

kenzie arkananta putra dharma

ANAK

03/09/2014

PUSKESMAS DAU

864

0002217926057 3573031808860003

2009118608181 001

AGUS SUBEKTI

PESERTA

18/08/1986

PUSKESMAS DAU

865

0000111898001 3507225806870003

2009118608181 001

KARTIKA WIJAYANTI

ISTRI

18/06/1987

PUSKESMAS DAU

866

0002217930129 3507221803120002

2009118608181 001

haldis abdillah hastungkara

ANAK

18/03/2012

PUSKESMAS DAU

867

0002217930265 3507221908150003

2009118608181 001

HILMI ABDILLAH HASTUNGKARA

ANAK

19/08/2015

PUSKESMAS DAU

868

0002217927576 3504052011810001

2009078111201 001

NOVA YOGANTORO

PESERTA

20/11/1981

DINOYO

869

0002217927666 3515065605840001

2009078111201 001

ANITA YUSTINA

ISTRI

16/05/1984

DINOYO

870

0002217928667 3573052910750004

2008127510291 001

M. SULTHON ANSHORY

PESERTA

29/10/1975

DINOYO

871

0002217931828 3510116010860008

2013018610202 00

PEPTIA ASRINING TYAS

PESERTA

20/10/1986

KARANG PLOSO

872

0002217931885 3509201011860004

2013018610202 00

RIZKY AGUNG NOVARIYANTO SUAMI

10/11/1986

KARANG PLOSO

1/31/17 4:02 PM

Page 49 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


873

0002217932008 3507236406130002

2013018610202 00

RISANINDYA AGUNG

ANAK

24/06/2013

KARANG PLOSO

874

0002217932335 3573050810870004

2009118710081 001

MOHAMMAD RIFQI SUFANDA

PESERTA

08/10/1987

JANTI

875

0002217932403 3573046907870005

2009118710081 001

VITTA RIZKY PERMATASARI

ISTRI

29/07/1987

JANTI

876

0002217935586 3507220207770004

2008127707021 001

SAIFUL

PESERTA

02/07/1977

PUSKESMAS DAU

877

0002217935632 3507224903760002

2008127707021 001

KASIANI

ISTRI

09/03/1976

PUSKESMAS DAU

878

0002217935687 3507221209960001

2008127707021 001

MOCH AGUNG SUDRAJAT

ANAK

12/09/1996

PUSKESMAS DAU

879

0002217935733 3507221512090001

2008127707021 001

MOCH IRFAN HAKIM

ANAK

15/12/2009

PUSKESMAS DAU

880

0002217936104 3507221812720002

2013057212121 001

SASE ADI KRISWANTO

PESERTA

18/12/1972

PUSKESMAS DAU

881

0002217936183 3507224102720003

2013057212121 001

NURUL AINI

ISTRI

01/02/1972

PUSKESMAS DAU

882

0002217936262 3507221802000002

2013057212121 001

ABIM BAYU SAPUTRA SASE

ANAK

18/02/2000

PUSKESMAS DAU

883

0002217936374 3507220209090001

2013057212121 001

ABEL ABHISEKA PUTRA SASE ANAK

02/09/2009

PUSKESMAS DAU

884

0002217936431 3516141608830004

2011068308161 001

VANDA HARDINATA

PESERTA

16/08/1983


885

0002217936532 3516145407830002

2011068308161 001

TINUK KUSUMANINGRUM

ISTRI

14/07/1983


886

0002217936688 3516144701120001

2011068308161 001

CARISSA NATHANIA NAYYARA ANAK

07/01/2012


887

0002217936892 3520124501750001

2011097501052 001

YENI WULANDARI

PESERTA

05/01/1975

REJOMULYO

888

0002217937061 3520122207710003

2011097501052 001

NUGROHO KATON

SUAMI

22/07/1971

REJOMULYO

1/31/17 4:02 PM

Page 50 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


889

0002217937162 3520125008970001

2011097501052 001

BERTHA FERNANDA NUR AVIVAH

ANAK

10/08/1997

REJOMULYO

890

0002219339158 3520121012030001

2011097501052 001

ABRAHAM MADE KUMARA

ANAK

10/12/2003

REJOMULYO

891

0002217937577 3573054511840004

2016010120101 120

YANA SHANTI MANIPUSPIKA

PESERTA

05/11/1984

DINOYO

892

0002217937781 3573053007120001

2016010120101 120

SATRIA GANTARA ANGKASA YUKA

ANAK

30/07/2012

DINOYO

893

0002217938354 3573051906880001

2012098806091 001

RUMADI ARBY QHOFATONI

PESERTA

19/06/1988

Klinik Bahrul Maghfiroh CI

894

0002217939096 3573022506740005

3573022506740 005

ANDY KURNIAWAN

PESERTA

25/06/1974

ARJUNO

895

0002217939232 3573026909720001

3573022506740 005

TWEGI PURNAMASARI

ISTRI

29/09/1972

ARJUNO

896

0002217939682 3573020609090002

3573022506740 005

GEORGIUS ARNESH CAKRA PURNAMA

ANAK

06/09/2006

ARJUNO

897

0002217939851 3573026406120006

3573022506740 005

FELECIA ALEXA REISHA KURNIAWAN

ANAK

24/06/2012

ARJUNO

898

0002217940604 3573055402890004

2013028902142 001

MARIA ULFA

PESERTA

14/02/1989

DINOYO

899

0002217940896 3573050501890004

2013028902142 001

ACHMAD DAMAIYANTO

SUAMI

05/01/1989

DINOYO

900

0002217943383 3525146010840001

8410201322099 0

INDAH NURUL AFIFAH

PESERTA

20/10/1984


901

0002217943506 3525145707150001

8410201322099 0

FITRI NURY ANDARA

ANAK

17/07/2015


902

0002217943934 3517081507780005

2009077807151 001

PITOYO WIDHI ATMOKO

PESERTA

15/07/1978


903

0002217944079 3275086004850030

2009077807151 001

DEWI ANGGUN PRAKARTINI

ISTRI

20/04/1985


904

0002217944171 3517084204140001

2009077807151 001

alyanoura aisyah atmaka

ANAK

02/04/2014


1/31/17 4:02 PM

Page 51 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


905

0002217944709 3507122303770002

2006057703231 001

wahyu tri sasongko

PESERTA

23/03/1977

SBR. PUCUNG

906

0002217945025 3507125310820007

2006057703231 001

irulya susanti

ISTRI

13/10/1982

SBR. PUCUNG

907

0002217945205 3507122602060002

2006057703231 001

m. riqki abqori

ANAK

26/02/2006

SBR. PUCUNG

908

0002217945251 3507125812070002

2006057703231 001

sarah azkia khoirunnisa

ANAK

08/12/2007

SBR. PUCUNG

909

0002217945396 3507124106110002

2006057703231 001

atika rizky amania

ANAK

01/06/2011

SBR. PUCUNG

910

0002217946105 3573051006920009

9206101321000 1

DINGGA PESONA TAKBIR ADHA

PESERTA

10/06/1992

DINOYO

911

0002217946274 3573045003640002

2011036403102 001

SRI PURWANINGSIH

PESERTA

10/03/1964

JANTI

912

0002217946318 3573040103630003

2011036403102 001

ARI MUWARDI

SUAMI

01/03/1963

JANTI

913

0002217946342 3573041210980001

2011036403102 001

RYAN ARDIANSYAH

ANAK

12/10/1998

JANTI

914

0002217946678 3573025301620001

2011076201132 001

SRI WIDJI WINANTI

PESERTA

13/01/1962

MOJOLANGU

915

0002217946972 3573050905620001

2013036205091 001

SUGIYANTO

PESERTA

09/05/1962

DINOYO

916

0002217947286 3515084910840003

2010078410092 001

KETHY HARIYADI PUTRI

PESERTA

09/10/1984

DINOYO

917

0002217947398 3522191805810004

2010078410092 001

MOCHAMAD SYAHRU ROCHMAT

SUAMI

18/05/1981

DINOYO

918

0002217947444 3515081911120001

2010078410092 001

MUHAMMAD HAYDAR ALTAMIS

ANAK

19/11/2012

DINOYO

919

0002217948401 3507242812650001

2011036512281 001

SUPARMAN

PESERTA

28/12/1965

SINGOSARI

920

0002217948467 3507246712710001

2011036512281 001

SUSI ARIATI

ISTRI

27/12/1971

SINGOSARI

1/31/17 4:02 PM

Page 52 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


921

0002217948568 3507247112980003

2011036512281 001

NADIA MARDHIYAH

ANAK

31/12/1998

SINGOSARI

922

0002217948671 3507242109060004

2011036512281 001

MOHAMMAD YUSUF FIRMANSYAH

ANAK

21/09/2006

SINGOSARI

923

0002217949121 3573052102800008

8002211321017 2

RIZKI AJI

PESERTA

21/02/1980

KENDALSARI

924

0002217949132 3573054802810020

8002211321017 2

INA WIJAYA

ISTRI

08/02/1981

KENDALSARI

925

0002217949176 3573055411020001

8002211321017 2

BEAUTY HIDAYAH RIZKI

ANAK

14/11/2002

KENDALSARI

926

0002217949198 3573055011110004

8002211321017 2

BEBY ANNISA RIZNA

ANAK

10/11/2011

KENDALSARI

927

0002217990699 3573055812770004

2014057712182 001

DEASY CHRISNIA NATALIA

PESERTA

18/12/1977


928

0002217991026 3573052205020002

2014057712182 001

MICHAEL AXEL ARISANTO

ANAK

22/05/2002


929

0002217991454 3508184809880001

2014058809082 001

EKA RATRI NOOR WULANDARI PESERTA

08/09/1988


930

0002217991926 3505146311870001

2014058911232 002

NOVITA ROSYIDA

PESERTA

23/11/1987

DINOYO

931

0002218329764 3507247008890007

2014118908302 001

NI'MATUL IZZA

PESERTA

30/08/1989

SINGOSARI

932

0002218330539 3524052009870001

2014118908302 001

ACHMAD YAZID ICHSAN

SUAMI

20/09/1987

SINGOSARI

933

0002218331057 3507244402160003

2014118908302 001

CHALYA SHAFIYAH

ANAK

04/02/2016

SINGOSARI

934

0002218336918 3578024712850001

2014058512720 01

SATWIKA DESANTINA MUKTININGSIH

PESERTA

07/12/1985

JANTI

935

0002218339181 3505173007860001

2015048607301 001

JOKO PRASETYO

PESERTA

30/07/1986

WLINGI

936

0002218339923 3505175905890002

2015048607301 001

RIRIN MUSTANTIA

ISTRI

19/05/1989

WLINGI

1/31/17 4:02 PM

Page 53 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


937

0002218340439 3505174811150002

2015048607301 001

SAKURA SALSABILA PRASETYO

ANAK

08/11/2015

WLINGI

938

0002218379084 3522115402780003

2014057802142 001

WAWID PURWATININGSIH

PESERTA

14/02/1978


939

0002218383347 3573014310830002

0002301201703

HAEDI OKTAVIANI

PESERTA

03/10/1983


940

0002218385913 3573012305100002

0002301201703

ARCIELLO GUSTI NUGROHO

ANAK

23/05/2010


941

0002218389895 3573036711840001

2014058411272 001

MIKO IRFANTI

PESERTA

27/11/1984


942

0002218391943 3573055301860004

0002301201704

HERDINA NURYASARININGTYAS

PESERTA

13/01/1986


943

0002218403136 3575035502880001

2012058802152 001

CHOIRO NIKMAH

PESERTA

15/02/1988


944

0002218405408 3573016712860001

2012058612270 01

NUR HERFIANTI, A.MD

PESERTA

27/12/1986

KLINIK ELISA

945

0002218417356 3572014203870004

2012018703022 001

LUSVITA ANGGRAINI

PESERTA

02/03/1987


946

0002218418774 3504012901820001

2010088201291 001

ANANG TRIONO

PESERTA

29/01/1982


947

0002218420359 3579032801840001

01

DIDIN MULIANTO

PESERTA

28/01/1984

JUNREJO

948

0002218420912 3507235910870001

01

IKA NOVIA SUSANTI

ISTRI

19/10/1987

JUNREJO

949

0002218422633 3579032907061731

01

jasmine auliya rahma prameswari ANAK

18/01/2016

JUNREJO

950

0002218424714 3524070105750004

001

ALI MANSHUR

PESERTA

01/05/1975


951

0002218425197 3507226712730001

001

ROSYIDATUL FADLILAH

ISTRI

27/12/1973


952

0002218425546 3507220801110002

001

SIRAJUL FAWWAZI

ANAK

08/01/2011


953

0002218426029 3507222311120001

001

MUHAMMAD RAFIF MAR'I

ANAK

23/11/2012


954

0002218429811 3573015012860004

2012018612102 001

PIPIT TUNJUNGSARI

PESERTA

10/12/1986


955

0002218432239 3507135304920004

01

AJENG KUSUMAWATY

PESERTA

13/04/1992

KEPANJEN

956

0002218435132 3572023005800002

02120002

HERI IRAWAN

PESERTA

30/05/1980


1/31/17 4:02 PM

Page 54 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


957

0002218435694 3573054904690003

02120002

DEWI ROSOWULAN

ISTRI

09/04/1969


958

0002218436212 3507231505120004

02120002

MUHAMAD ZULFIKAR DE IRAWAN

ANAK

15/05/2012


959

0002218435839 3372036803920001

01

INDRI HAPSARI

PESERTA

28/03/1992

DINOYO

960

0002218440868 3526016611860002

2012018611262 001

BINTANG HESTIKA LIA

PESERTA

26/11/1986


961

0002218441138 3526010411830009

2012018611262 001

HASAN BASRI

SUAMI

04/11/1983


962

0002218441421 3526011701140003

2012018611262 001

SULTAN ABYAN SHAKEEL

ANAK

17/01/2014


963

0002218443254 3573035810820008

2008018201820 01

LINA RAKHMASARI

PESERTA

18/10/1982

DYAH PALUPI, dr

964

0002218443603 3573051208820006

2008018201820 01

WAHYU MAHARDIKA

SUAMI

12/08/1982

DYAH PALUPI, dr

965

0002218443906 3573034106130006

2008018201820 01

LUQYANA SAKHI MAHARDIKA

ANAK

01/06/2013

DYAH PALUPI, dr

966

0002218443502 3507215002880003

2012018880210 200

DYAH ERIESA MUTYA

PESERTA

10/02/1988


967

0002218443748 3573050910860001

2012018880210 200

AGUNG BUDI LEKSONO

SUAMI

09/10/1986


968

0002218443963 3573050604140001

2012018880210 200

KEENAN ARKANA BAKSYA

ANAK

06/04/2014


969

0002218443772 3507094112890002

2012058912012 001

EKA DESIANA HARI I

PESERTA

01/12/1989

PAMOTAN

970

0002218447359 3514086408840001

2010088408242 001

AVIVATUL LAILYA,SE

PESERTA

24/08/1984

PURWOSARI

971

0002218448395 3579034812770006

2010087712082 001

SITI KHOMARIYAH, SE

PESERTA

08/12/1977

JUNREJO

972

0002218448575 3579031402620001

2010087712082 001

DRS. AANK JAUHARI SAKENE, SUAMI SH

14/02/1962

JUNREJO

973

0002218448687 3579030109070001

2010087712082 001

RASYA FARAND AL FAHREZI

01/09/2007

JUNREJO

1/31/17 4:02 PM

ANAK

Page 55 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


974

0002218448417 3571014712790005

2012127912072 001

RETNO PALUPI

PESERTA

07/12/1979

TEGAR FADELI, DR

975

0002218449339 3571012711810004

2012127912072 001

YOHAN SUPANDI HADI KUNCORO

SUAMI

27/11/1981

TEGAR FADELI, DR

976

0002218449565 3571014101050001

2012127912072 001

FAIQATUL HIMMAH

ANAK

01/01/2005

TEGAR FADELI, DR

977

0002218449971 3571014603100001

2012127912072 001

AZMI NAAFI'AH

ANAK

06/03/2010

TEGAR FADELI, DR

978

0002218448542 3579027012840001

2012018412302 001

INDRAWATI

PESERTA

30/12/1984


979

0002218448801 3579012909820007

2012018412302 001

FARISKA BISRI PURWANTOKO SUAMI

29/09/1982


980

0002218449003 3579027101100001

2012018412302 001

KHANSA ZAYAN LATIFAH

ANAK

31/01/2010


981

0002218449262 3579026805120002

2012018412302 001

ASKANA SAKHI FARISKA

ANAK

28/05/2012


982

0002218450285 3507192802810003

2010088112272 000

EKO SLAMET MUJIYANTO

PESERTA

28/02/1981

PAKISAJI

983

0002218450364 3507194303840005

2010088112272 000

RINI SUMININGSIH

ISTRI

03/03/1984

PAKISAJI

984

0002218450421 3507194709050002

2010088112272 000

EKA RANI KARISMASARI

ANAK

07/09/2005

PAKISAJI

985

0002218450498 3507195407100002

2010088112272 000

ALMIRAH MAHARDIKA

ANAK

14/07/2010

PAKISAJI

986

0002218451692 3505196908860001

2012018608292 00

ISMIATUN

PESERTA

29/08/1986


987

0002218452265 3505192304870001

2012018608292 00

ANDRI KURNIAWAN

SUAMI

23/04/1987


988

0002218452827 3573041411790004

2008067911141 001

DITO WAHYU

PESERTA

14/11/1979


989

0002218453402 3573046701740001

2008067911141 001

WIDJAYANTI

ISTRI

27/01/1974


1/31/17 4:02 PM

Page 56 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


990

0002218453659 3573044611040001

2008067911141 001

FADHILAH ZUKHRUF RAMADHANI

ANAK

06/11/2004


991

0002218453806 3573041002120002

2008067911141 001

CAESAR MAULANA MALIK AL JAZARY

ANAK

10/02/2012


992

0002218454065 3506135303850002

2012058503132 001

RIFA RAHMA ANDRIANA

PESERTA

13/03/1985

KLINIK DAQU SEHAT

993

0000098846122 3506222210840001

2012058503132 001

ahmad yunus aldino

SUAMI

22/10/1984

KLINIK DAQU SEHAT

994

0002218455459 3506132708130002

2012058503132 001

MUHAMMAD ALIF AL AZZAM

ANAK

27/08/2013

KLINIK DAQU SEHAT

995

0002218455325 3573013103820002

8203310121032 3

danang biantoro

PESERTA

31/03/1982


996

0002218455562 3573016303890001

8203310121032 3

HENNY PUSPITA SARI

ISTRI

23/03/1989


997

0002218772968 3573014803160005

8203310121032 3

SUKMA BENING NURANI

ANAK

08/03/2016


998

0002218455382 3573055904710005

2013047104192 001

ANITA BALQIS

PESERTA

19/04/1971


999

0002218455933 3573052911650001

2013047104192 001

dwi prasetyawan

SUAMI

29/11/1965


1,000 0002218456732 3573052006000002

2013047104192 001

muhammad juniandana

ANAK

20/06/2000


1,001 0002218456157 3507096011840008

201205841120220010

novia eka wati

PESERTA

20/11/1984

SINGOSARI

1,002 0002218456484 3507092111810002

201205841120220010

yoyok bagus irianto

SUAMI

21/11/1981

SINGOSARI

1,003 0002218456888 3507090804712000

201205841120220010

bima nayaka putra irianto

ANAK

08/04/2012

SINGOSARI

1,004 0002218457496 3318121005850001

2008128505101 001

junaedi mulyo prayidno

PESERTA

10/05/1985


1,005 0002218457687 3507191908830003

8308190121018 6

SRI AGUS CAHYONO

PESERTA

19/08/1983

Klinik PG Kebonagung

1,006 0002218458161 3507256004830002

2010088112200 001

erma riestiana kartika

PESERTA

20/04/1983

LAWANG

1/31/17 4:02 PM

Page 57 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,007 0002218458778 3522102603770003

2012107703261 001

ACHMAD GHUFRON RIZA

PESERTA

23/03/1977


1,008 0002218458925 3522105209890005

2012107703261 001

SITI MUNTAROH

ISTRI

12/09/1989


1,009 0002218459037 3522105708110003

2012107703261 001

NAYRA AISYAH RAMADHANI

ANAK

17/08/2011


1,010 0002218458958 3505181501850001

2012058501151 001

DIDIK WIYONO

PESERTA

15/01/1985

KLINIK BRAWIJAYA LAWANG

1,011 0002218460319 3505186609860001

2012058501151 001

CICIK SAPTIKASARI

ISTRI

26/09/1986


1,012 0002218460365 3507255507110002

2012058501151 001

HASNA SYIFA AMALIA

ANAK

15/07/2011


1,013 0002218460512 3507252211100002

2012058501151 001

MAYLA WAFIY NAFIAH

ANAK

01/04/2013


1,014 0002218459015 3504181608870002

2012058708161 001

dwaji galih mahardika

PESERTA

16/08/1987


1,015 0002218459083 3573016805800005

2010088005282 001

alifha

PESERTA

28/05/1980

KENDAL KEREP

1,016 0002218459858 3507186508860004

2012058608252 001

agustina triyolanda

PESERTA

25/08/1986

PAKIS

EVI SULVIANI NENGSEH

PESERTA

26/03/1989

dr. HARDJITO

1,017 0002218460095 3517136603890001

201205890326220010

1,018 0002218460681 3573052709780012

2007117809171 001

suryawan

PESERTA

27/09/1978


1,019 0002218460736 3573054103800014

2007117809171 001

susanti

ISTRI

01/03/1980


1,020 0002218460771 3573055608020006

2007117809171 001

adilla puspita sari

ANAK

16/08/2002


1,021 0002218460859 3573050305110002

2007117809171 001

rifky surya pratama

ANAK

03/05/2011


1,022 0002218460793 3573030712820006

2013018212071 001

andi bahtiar

PESERTA

07/12/1982


1,023 0002218461311 3507032704830002

8304270621064

heru purwanto

PESERTA

27/04/1983

KLINIK DAQU SEHAT

1/31/17 4:02 PM

Page 58 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


5 1,024 0002218461399 3507034904810001

8304270621064 5

lida suesmi

ISTRI

09/04/1981

KLINIK DAQU SEHAT

1,025 0002218461423 3507033112080002

8304270621064 5

zaidan herda kurnia sandi

ANAK

31/12/2008

KLINIK DAQU SEHAT

1,026 0002218461355 3573031608072575

2013038506131 001

YOHAN WICAKSONO

PESERTA

13/06/1985


1,027 0002218461467 7315065801870002

2013038506131 001

laura esterrita

ISTRI

18/01/1987


1,028 0002218461412 3574026811890002

011

genta mahardhika rozalinnA

PESERTA

28/11/1969

DINOYO

1,029 0002218461748 3507190111850003

2008028511011 001

GUNTUR ROY HERMINTO

PESERTA

01/11/1985


1,030 0002218462029 3507195412820002

2008028511011 001

MUJI TRI SUSANTI

ISTRI

14/12/1982


1,031 0002218462143 3507192111110001

2008028511011 001

ABBRA BHUM ANDALLA BYOMA

ANAK

21/11/2012


1,032 0002218461884 3573036106750011

2010087506212 001

MOEDJIONO IRDWI JUNI KARTIKA

PESERTA

21/06/1975


1,033 0002218462154 3573034210080005

2010087506212 001

jihan ayudyah mutiarasari

ANAK

02/10/2008


1,034 0002218462018 3507130401780004

01

YUS WIDIYANTO

PESERTA

04/01/1978

KEPANJEN

1,035 0002218462457 3507136912890005

01

SITI MAYSAROH

ISTRI

29/12/1989

KEPANJEN

1,036 0002218462738 3507136110080001

01

VITA RAHMALIA WIDIYANTO

ANAK

21/10/2008

KEPANJEN

1,037 0002218462571 3579013112700003

2012017012311 001

ALFAN FATHONI

PESERTA

31/12/1970


1,038 0002218462716 3579016301740002

2012017012311 001

erniati

ISTRI

23/01/1974


1,039 0002218462852 3579014406000003

2012017012311 001

maulidit icha noer hannyva

ANAK

04/06/2000


1,040 0002218462727 3573022707760001

2010087607271 001

muhammad hidayat

PESERTA

25/04/1979

ARJUNO

1/31/17 4:02 PM

Page 59 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,041 0002218462795 3573026504790002

2010087607271 001

wahyuning astuti

ISTRI

25/04/1979

ARJUNO

1,042 0002218462863 3573021708080002

2010087607271 001

abdullah umar hidayat

ANAK

17/08/2008

ARJUNO

1,043 0002218462874 3573021710110001

2010087607271 001

muhammad hisyam

ANAK

17/10/2011

ARJUNO

1,044 0002218462806 3573011601880003

0002301201707

giat pornomo

PESERTA

10/01/1988

PANDANWANGI

1,045 0002218462986 3573032208830003

2008128308221 001

HARRIS TRISTANTO

PESERTA

22/08/1983

DYAH PALUPI, dr

1,046 0001433807234 3573034204880013

2008128308221 001

RIZKY CHINTANI APRILIA

ISTRI

02/04/1988

DYAH PALUPI, dr

1,047 0001433807537 3573031511080007

2008128308221 001

SATYA ARYA PRADITYA

ANAK

15/11/2008

DYAH PALUPI, dr

1,048 0001433807842 3573035709130002

2008128308221 001

NAURA CALLISTA AZZAHRA

ANAK

17/09/2013

DYAH PALUPI, dr

1,049 0002218463008 3573050903800006

2012098003091 001

MOCHAMMAD HASBI AS SADDIQI

PESERTA

09/03/1980


1,050 0002218463065 3317126309830003

2012098003091 001

EMA SAPTARINI

ISTRI

23/09/1983


1,051 0002218463144 3573051412080004

2012098003091 001

MOCHAMAD RIFALDI AS SIDDIQI

ANAK

14/12/2008


1,052 0002218463188 3318081111850002

851

GEORGE TOWARIKBAL TAWAKKAL

PESERTA

11/11/1985


1,053 0002218463594 3318085805880021

851

NUNUNG FITRIANA

ISTRI

18/05/1988


1,054 0002218463831 3318082108120003

851

HIMADA JIBRIL JUAN JAVAS TAWAKKAL BANIYOSO

ANAK

21/08/2012


1,055 0002218463201 3573024503760005

7603050622011 6

henny tirtasari

PESERTA

05/03/1976


1,056 0002218463245 3573012705760003

7603050622011 6

dani lazuardi

SUAMI

27/05/1976


1,057 0002218463324 3573026111040005

7603050622011 6

nova fitria puspasari

ANAK

21/11/2004


1/31/17 4:02 PM

Page 60 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,058 0002218463223 3573031510880003

2012018810152 11

aditya hari bawono

PESERTA

15/10/1988

KLINIK ELISA

1,059 0002218463291 3579032406840001

2010088406241 001

dhino teguh prasetyo

PESERTA

24/06/1984

JUNREJO

1,060 0002218463561 3573011010670006

001215165155

HANDOKO

PESERTA

10/10/1967


1,061 0002218463651 3573016812690003

001215165155

LATIFA MURTIANI

ISTRI

28/12/1969


1,062 0002218463785 3573012703970007

001215165155

ARSHA MAULANA

ANAK

27/03/1997


1,063 0002218463842 3573014111010002

001215165155

TALITHA ALYADIVA

ANAK

01/11/2001


1,064 0002218463921 3573016701100006

001215165155

ALINA SHAFA KAMILA

ANAK

27/01/2010


1,065 0002218463919 3514110811780004

2013027811081 001

WAWAN NOFARIANTO

PESERTA

08/11/1978


1,066 0002218463932 3514114409810001

2013027811081 001

JUMIATI

ISTRI

04/09/1981


1,067 0002218463987 3514110207120002

2013027811081 001

MUHAMMAD GIBRAN AINUL YAQIN

ANAK

02/07/2012


1,068 0002218463976 3573057005800004

002011028005302001

NURUL INDRAWATI

PESERTA

30/05/1980


1,069 0002218467047 3573051607060009

002011028005302001

BEVAN ALBIN JULIANANTA P

ANAK

16/07/2006


1,070 0002218467069 3573051012120002

002011028005302001

ZAVERIO ABISATYA ALFAREZEL

ANAK

10/12/2012


1,071 0002218467126 3573056506150005

002011028005302001

QUEENSHA RAMADHANI PUTRI NURA KINANTI

ANAK

26/06/2015


1,072 0002218464314 3573053003810001

2013028103302 100

supriadi

PESERTA

30/03/1981


1,073 0002218464358 3572954311830001

2013028103302 100

NURUL KHASANAH

ISTRI

03/11/1983


1,074 0002218464404 3573052504080006

2013028103302 100

MOCH. ASYRAFI SUNU

ANAK

25/04/2008


1,075 0002218464437 3573052204150003

2013028103302 100

MUHAMMAD SYAFIQ ASFA SUNU

ANAK

22/04/2015


1,076 0002218464448 3507201610880001

2012028810162 101

ahmad zam zam almaqi

PESERTA

16/10/1988

NGAJUM

1/31/17 4:02 PM

Page 61 of 91

Nama Satuan Kerja : DEPDIKBUD UNIBRAW NIP. Baru

Nama

Hub. Keluarga


1,077 0002218464538 3507226711830001

002010108311272001

RATIH PRAWASTI

PESERTA

27/11/1983


1,078 0002218464731 3507221812790003

002010108311272001

ROLAND SUMARNA

SUAMI

18/12/1979


1,079 0002218464808 3507221003040001

002010108311272001

IVAN INDRA PRAWIRA RAHARDJO

ANAK

10/03/2004


1,080 0002218464854 3507222702080001

002010108311272001

BAGOES INDRA PRAWIRA RAHARDJO

ANAK

27/02/2006


1,081 0002218464887 3507220310120001

002010108311272001

MAHARDIKA INDRA PRAYOGI RAHARDJO

ANAK

03/10/2012


No.

No. Kartu

NIK

NIP. Lama

1,082 0002218464685 3573022302650001

01

MUJI EKO SUSILO

PESERTA

23/02/1965

DINOYO

1,083 0002218464696 3573056501790003

2012087901252 201

THUSTI DWI PURNAMI

PESERTA

25/01/1979

DINOYO

1,084 0001270418962 3573051511780011

2012087901252 201

NOVIAR AGUNG GITANTO

SUAMI

15/11/1978

DINOYO

1,085 0002218464999 3573050311040007

2012087901252 201

m. fadhil razzan al faraz

ANAK

03/11/2004

DINOYO

1,086 0002218465102 3573056207080001

2012087901252 201

alyssa nabiha

ANAK

22/07/2008

DINOYO

1,087 0002218465135 3573055512100002

2012087901252 201

asyfa nabiha

ANAK

15/12/2010

DINOYO

1,088 0002218464821 3507240910900010

2013029010091 001

ahmad sobahus surur

PESERTA

09/10/1990

dr. ERNI INDRIATI (JST)

1,089 0002218465157 3571036906800007

2012098006292 001

ARMAWANAH

PESERTA

29/06/1980

KLINIK SAMUDRA HUSADA KUSUMA

1,090 0002218465326 3571030212770002

2012098006292 001

hari dwiatmadi

SUAMI

02/12/1977


1,091 0002218465574 3573052110850005

2012058510212 101

FRANSISCUS PRIHARSONO

PESERTA

21/10/1985

MOJOLANGU

1,092 0002218465787 3572037009880003

01

kurnia mursitowati

PESERTA

30/09/1988

DINOYO

1,093 0000111922457 3573052611870002

01

MOCHAMMAD FAJAR

SUAMI

26/11/1987

DINOYO

1,094 0002218466182 3573052004150003

01

mochammad fahlevi

ANAK

20/04/2015

DINOYO

1/31/17 4:02 PM

Page 62 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


PESERTA

02/04/1987

DINOYO

1,095 0002218465844 3515180204870003

2012058709022 101

AKBAR WIDIANTO PRATAMA

1,096 0002218465991 3509194404880004

2012058709022 101

husnul hotimah hadiatul hasanah ISTRI

04/04/1988

DINOYO

1,097 0002218466013 3515187107140003

2012058709022 101

azkia alisha widiasari

ANAK

31/07/2014

DINOYO

1,098 0002218465855 3506255104860001

2012108604112 001

wanodya pradnya paramita

PESERTA

11/04/1986


1,099 0002218465978 3506252502140001

2012108604112 001

aguero zafiro abisha

ANAK

25/02/2014


1,100 0002218466171 3318214411880002

2210

irma fitriana ulfah

PESERTA

04/11/1988


1,101 0002218466272 3573020301890002

2013028901032 101

yanuar widiantono

PESERTA

03/01/1989

JUNREJO

1,102 0000112033631 3579035304900001

2013028901032 101

RICHA RISNA PRIYANTI

ISTRI

13/04/1990

BEJI

1,103 0002218466362 3579030907150001

2013028901032 101

julian putra bryantono

ANAK

09/07/2015

JUNREJO

1,104 0002218466373 3573052512860002

2013028612251 001

HERU TRI PRASETYO

PESERTA

25/12/1986


1,105 0002218466575 3573042903880004

2013028803292 100

SAMSUL HUDA

PESERTA

29/03/1988


1,106 0002218466586 3514022212830004

2013058312222 101

daud siswo sarjono

PESERTA

22/12/1983

NONGKOJAJAR

1,107 0002218466643 3514026312900001

2013058312222 101

ike rahayu wahyuningsih

ISTRI

23/12/1990

NONGKOJAJAR

1,108 0002218466676 3514020707090001

2013058312222 101

feliccois michael sarjono

ANAK

07/07/2009

NONGKOJAJAR

1,109 0002218466733 3573022801840004

002012028401281001

NANANG WIJAYANTO

PESERTA

28/01/1984


1,110 0002218466812 3573024810100002

002012028401281001

IRMADEL CALYA NATANIA AZKA W

ANAK

08/10/2010


1,111 0002218466902 3573026102150001

002012028401281001

LATIDHA AQUINA ARSY WIJAYANTO

ANAK

21/02/2015


1/31/17 4:02 PM

Page 63 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,112 0002218466788 7304031609740001

010

muhutar haboddin

PESERTA

16/09/1974

DINOYO

1,113 0001260101665 3671134702810008

010

FIRLY NOORSANTY

ISTRI

07/02/1981


1,114 0002218466799 3329151112920006

01

DENY PRASETYO

PESERTA

11/12/1992

DINOYO

1,115 0002218466834 3573031803890001

2012078903182 101

IVAN YULFRIAN

PESERTA

18/03/1989

KEDUNG KANDANG

1,116 0002218466889 3507185107890001

2012078903182 101

chujjatul arofah

ISTRI

11/07/1989

KEDUNG KANDANG

1,117 0002218466924 3573036106130006

2012078903182 101

sanabila raihanah

ANAK

21/06/2013

KEDUNG KANDANG

1,118 0002218466957 3573030103160002

2012078903182 101

shalih fauzan

ANAK

01/03/2016

KEDUNG KANDANG

1,119 0002218466891 3573050107900036

2013029010032 100

CHOIRUL NASIKIN

PESERTA

03/10/1990


1,120 0002218467025 3507182411900003

2013059011241 001

AHMAD EKO SYARIFUDIN

PESERTA

24/11/1990


1,121 0002218467161 3514132408810001

2014028108242 100

IFAN SYAHRUDIN BACHTIYAR PESERTA

24/08/1981


1,122 0002218467194 3514135207810005

2014028108242 100

listyaningrum

ISTRI

12/07/1981


1,123 0002218467238 3514135805070002

2014028108242 100

chairani elisyath mumtazah

ANAK

18/05/2007


1,124 0002218467295 3573052203120010

2014028108242 100

argantha aqila bachtiar

ANAK

22/03/2012


1,125 0002218467339 3573055702160005

2014028108242 100

maheswari karuna zhufairah

ANAK

17/02/2016


1,126 0002218467227 3375020911900006

2011109011091 001

m. nofirda fal's

PESERTA

09/11/1990

dr. HENRY MULYONO (JST)

1,127 0002218467284 3573051812140009

002012028704031001

ANDYAN DWI ARDANA

PESERTA

03/04/1987


1,128 0002218467385 3573050403150001

002012028704031001

HAMIZAN ABID AQILA MANAF

ANAK

04/03/2015


DWI NUR INDAH LESTARI

PESERTA

26/01/1988

DINOYO

1,129 0002218467363 3573056606880002

1/31/17 4:02 PM

2012078806262 201

Page 64 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,130 0002218467486 3573050305880007

01

BAYU KURNIA RAMADHAN

PESERTA

03/05/1988

MOJOLANGU

1,131 0002218467508 3573041704730011

2008027304171 001

MOCHAMMAD CHOIRUL

PESERTA

17/04/1973


1,132 0002218467543 3573046505810009

2008027304171 001

SITI HANIPAH

ISTRI

25/05/1981


1,133 0002218467576 3573042005070009

2008027304171 001

MOCHAMMAD AUFAR MUBARRAK

ANAK

29/05/2007


1,134 0002218467598 3573045012120002

2008027304171 001

NUR AZIZAH CHOIRUNNISA

ANAK

10/12/2012


1,135 0002218496589 3507134202890002

2013058902022 001

ANGGUN RINDANG CEMPAKA PESERTA

02/02/1989


1,136 0002218538485 3575023108710002

002009107108311001

IWAN PUJIONO BINTORO

PESERTA

31/08/1971

KLINIK WIDYA HUSADA

1,137 0002218539295 3575027006820003

002009107108311001

EKA PUJI ASTUTIK

ISTRI

30/06/1982

KLINIK WIDYA HUSADA

1,138 0002218553289 3575020507020003

002009107108311001

YOSI ROKHMANSYAH

ANAK

05/07/2002

KLINIK WIDYA HUSADA

1,139 0002218542579 3573054309850002

2012088509032 001

AINA ANGELINA

PESERTA

03/09/1985


1,140 0002218542928 3573050111110008

2012088509032 001

AL RASYID MAULANA RACHMAN

ANAK

01/11/2011


1,141 0002218593892 3573012512700003

2011117012251 001

KRISMANTO

PESERTA

25/12/1970

KLINIK WIDYA HUSADA

1,142 0002218594252 3573016105780003

2011117012251 001

LUSIANA

ISTRI

21/05/1978

KLINIK WIDYA HUSADA

1,143 0002218594803 3573016312030001

2011117012251 001

SEKAR KINASIH

ANAK

23/12/2003

KLINIK WIDYA HUSADA

1,144 0002218595321 3573016107070004

2011117012251 001

RATNA PARAMITA

ANAK

21/07/2007

KLINIK WIDYA HUSADA

1,145 0002218595962 3573015012110001

2011117012251 001

TANIA KRISSIANA EFKA

ANAK

10/12/2011

KLINIK WIDYA HUSADA

1,146 0002218609798 3573054711810003

2006088111072 001

INTAN DAMAYANTI

PESERTA

07/11/1981

DINOYO

1,147 0002218612735 3674020307820002

2006088111072 001

WISNU BUDIWASTIKNO

SUAMI

03/07/1982

DINOYO

1/31/17 4:02 PM

Page 65 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,148 0002218613141 3573051811140002

2006088111072 001

MUHAMMAD SHABIR ABDURRAHMAN MURWANTO

ANAK

18/11/2014

DINOYO

1,149 0002218637474 3507194204770001

7704020722031 6

ELY SAFITRI

PESERTA

02/04/1977

PAKISAJI

1,150 0002218639509 3507190201740001

7704020722031 6

KHOIRUL ROZIKIN

SUAMI

02/01/1974

PAKISAJI

1,151 0002218640499 3507192602020001

7704020722031 6

MUHAMMAD NAUFAL KHULUKIN NOER

ANAK

26/02/2002

PAKISAJI

1,152 0002218641399 3507195012080002

7704020722031 6

THUFAILAH AL AFIFAH

ANAK

10/12/2008

PAKISAJI

1,153 0002218641862 3507190910110002

7704020722031 6

ACHMAD FAIRUS FACHRUDDIN

ANAK

09/10/2011

PAKISAJI

1,154 0002218641175 3525161608830021

feb004

MUCHAMMAD ZAMRONI

PESERTA

16/08/1983

CIPTOMULYO

1,155 0002218641557 3515025608910005

feb004

YENI SUTIKANINGSIH

ISTRI

16/08/1991

CIPTOMULYO

1,156 0002218641805 3573024106160001

feb004

ADIBA MARWA MAISUN

ANAK

01/06/2016

CIPTOMULYO

1,157 0002218650489 3573011304870004

2012088704131 001

DICKY FAIZAL IRNANDI

PESERTA

13/04/1987


1,158 0000111881518 3573055505870017

2012088704131 001

PUTRI HERLIA PRAMITASARI

ISTRI

15/05/1987


1,159 0002218757049 3573017007140004

2012088704131 001

DEVITRI SOPHIA MARYAM

ANAK

30/07/2014


1,160 0002218730938 3504054606890001

feb005

AJENG FITRIANI

PESERTA

06/06/1989

MULYOREJO

1,161 0002218732716 3504010511850002

feb005

FATCHUL MONGIN ARIF

SUAMI

05/11/1985

MULYOREJO

1,162 0002218732828 3504015601140001

feb005

SYAKIRA AZWAN NAFSI

ANAK

16/01/2014

MULYOREJO

1,163 0002218736632 3507065903930001

feb003

YETI RACHMA PURWANDARI

PESERTA

19/03/1993

DINOYO

1,164 0002218746306 3573051707840001

feb006

ANJAR PRASETYO YULIANTO

PESERTA

17/07/1984

DINOYO

1,165 0002218747836 3573056303850001

feb006

INDRAWATI

ISTRI

23/03/1985

DINOYO

1,166 0002218747961 3573051911150007

feb006

ANDRI PRASETYO KURNIA NOVIANTO

ANAK

19/11/2015

DINOYO

1/31/17 4:02 PM

Page 66 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


PESERTA

12/09/1976

MOJOLANGU

1,167 0002218766681 3573055209760003

2010117609122 200

PRASANTI ENDAH LESTARI, SE.

1,168 0002218769572 3573050809050008

2010117609122 200

MUHAMMAD RADJA PRAWIRO ANAK UTOMO

08/09/2005

MOJOLANGU

1,169 0002218780282 3524154803730002

6578393927464 557

EMMI ARFA'IYAH

PESERTA

08/03/1973


1,170 0002218781981 3573051509770002

7709150711029 6

AGUNG RIYANTO BUDI SANTOSO

PESERTA

15/09/1977


1,171 0002218782554 3573055404810001

7709150711029 6

TITI KARTIKA NORMASARI

ISTRI

14/04/1981


1,172 0002218783026 3573054810040006

7709150711029 6

SHAFA'AZIIZA SALSABILA

ANAK

08/10/2004


1,173 0002218783408 3573054912080004

7709150711029 6

TSABITA TSARWA SYAROZA

ANAK

09/12/2008


1,174 0002218784477 3573056408110003

7709150711029 6

NAYLA ALYA RAMADHANI

ANAK

24/08/2011


1,175 0002218786277 3575025604870001

2014058704162 001

RIMA DEWI AVIANTI

PESERTA

16/04/1987

PUSKESMAS DAU

1,176 0002218796831 3575032907870004

2014058704162 001

ADITYA BAGUS PERMANA

SUAMI

29/07/1987

PUSKESMAS DAU

1,177 0002218803568 3575031407140001

2014058704162 001

DARI ILHAM RAMADHAN

ANAK

14/07/2014

PUSKESMAS DAU

1,178 0002218792105 3573051508780007

7382987486276 383

AGUSTIONO

PESERTA

15/08/1978

MOJOLANGU

1,179 0002218793591 3573056110770001

7382987486276 383

MULYANI

ISTRI

21/10/1977

MOJOLANGU

1,180 0002218797448 3573056408030002

7382987486276 383

AMALIA AGUSTIN

ANAK

24/08/2003

MOJOLANGU

1,181 0002218798067 3573051009120006

7382987486276 383

AKMAL NAUFAL FALAH

ANAK

10/09/2012

MOJOLANGU

1,182 0002218795986 3573052703810001

2011048103271 001

ARDHIAN WAHYU SUDIANTO

PESERTA

27/03/1981


1/31/17 4:02 PM

Page 67 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,183 0002218800644 3573016602110005

2011048103271 001

AILA ABBY DZAKIRA

ANAK

26/02/2011


1,184 0002218801566 3573055802870013

8702180712026 9

ZUHROTUN ULYA

PESERTA

18/02/1987


1,185 0002218812186 3529014611890003

2013028911062 001

NURUL QOMARIYAH

PESERTA

06/11/1989


1,186 0002218812603 3573051206760010

feb010

SHOLEH SUHARSONO

PESERTA

12/06/1976

DINOYO

1,187 0002218812805 3573054411770002

feb010

MIMIN LASMI

ISTRI

04/11/1977

DINOYO

1,188 0002218813042 3573056808000003

feb010

ANANDA YUMNATUS SYAFIRA ANAK

28/08/2000

DINOYO

1,189 0002218813233 3573056108060001

feb010

ADINDA FARIKHATUZ ZAHRA

ANAK

21/08/2006

DINOYO

1,190 0002218813457 3573054408130001

feb010

AKIFATUS SYAROFANA RAMADHANI

ANAK

04/08/2013

DINOYO

1,191 0002218816372 3529262605890001

6478397456273 864

AHMAD NURHADI

PESERTA

26/05/1989


1,192 0002218819342 3506236003880003

2014058803202 001

IRMA ROSMALA SARI

PESERTA

20/03/1988


1,193 0002218825157 3507181002870006

2013098702101 001

M LUQMAN FADLI

PESERTA

10/02/1987

PAKIS

1,194 0002218826024 3510074202890002

2013098702101 001

ADITYA NOORMA ARISTA

ISTRI

02/02/1989

PAKIS

1,195 0002218827306 3507182205140001

2013098702101 001

muhammad arfan habibi

ANAK

22/05/2014

PAKIS

1,196 0002218834989 3573052110890004

feb011

GIGIH EKO WAHYU PRASETYO PESERTA

21/10/1989

DINOYO

1,197 0002218836868 3573021104840003

feb012

AGUS ARIANTO

PESERTA

11/04/1984


1,198 0002218837206 3507193008840002

2012108408301 001

SULISTIO

PESERTA

30/08/1984


1,199 0002218837476 3507196811900002

2012108408301 001

SUYATI

ISTRI

28/11/1990


1,200 0002218837882 3507196804100003

2012108408301 001

JASMINE IN AMATU ZUEHARO ANAK

28/04/2010


1/31/17 4:02 PM

Page 68 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,201 0002218838736 3507106203880001

2012058803222 001

DINIL MAGHFIROH

PESERTA

22/03/1988


1,202 0002218840301 3573035509150005

2012058803222 001

AYSHA RUNA CALLISTA PRADANA

ANAK

15/09/2015


1,203 0002218839052 3573022012800004

2013018012201 001

DONI SETIAWAN

PESERTA

20/12/1980


1,204 0002218840479 3573016309850001

2013018012201 001

TRI NUR WIJAYANTI

ISTRI

23/09/1985


1,205 0002218841098 3573011910120002

2013018012201 001

RAZQA NAZRIEL ALVARO

ANAK

19/10/2012


1,206 0002218843315 3507133012820004

9864782536746 536

HENDRA DWI SUBASTIONO

PESERTA

30/12/1982


1,207 0002218844856 3507134202830007

9864782536746 536

TITIN HARIANINGSIH

ISTRI

02/02/1983


1,208 0002218845205 3507132309090002

9864782536746 536

MOHAMMAD PANDU PRATAMA ANAK

23/09/2009


1,209 0002218845497 3507134108150004

9864782536746 536

AJENG SHAHIA LANI

ANAK

01/08/2015


1,210 0002218844215 3573051110760009

feb013

LUTHFI SYAMSIAR

PESERTA

11/10/1976


1,211 0002218844441 3573054611780004

feb013

YOSI SAFITRI

ISTRI

06/11/1978


1,212 0002218844654 3573054703050003

feb013

SASMITHA ARDIARINI

ANAK

07/03/2005


1,213 0002218844698 3573055011070003

feb013

BERLIANTINA INDRASARI

ANAK

10/11/2007


1,214 0002218844777 3573056810110004

feb013

ALMIRA DIANA

ANAK

28/10/2011


1,215 0002218844823 3573024506870001

2014048706052 001

OLIVIA ANGGRAENY

PESERTA

05/06/1987


1,216 0002218845014 3175090711840005

2014048706052 001

NYOMAN INDRA BAYU

SUAMI

07/11/1984


1,217 0002218849121 3508010806790002

feb014

EKO PRASETYO

PESERTA

08/06/1979

KARANG PLOSO

1,218 0002218866838 3507094108840001

2008098409012 001

NUR FITRIANAH

PESERTA

01/08/1984

TUREN

1/31/17 4:02 PM

Page 69 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,219 0002218871226 3524122806880002

feb017

MAHENDRA DWI CAHYA PUTRA

PESERTA

28/06/1988

DINOYO

1,220 0001447684929 3514116211890001

feb017

FRISKA RUSVIJAYATI

ISTRI

22/11/1989

PANDAAN

1,221 0002218871283 3573010504730009

2008127304051 001

ARIEF KUNCORO

PESERTA

05/04/1973

CISADEA

1,222 0002218871586 3573015904810006

2008127304051 001

YUNI NURWATININGSIH

ISTRI

19/04/1981

CISADEA

1,223 0002218871867 3573015207030002

2008127304051 001

FIRA YUNITA RIZKI SAPUTRI

ANAK

12/07/2003

CISADEA

1,224 0002218872249 3573011301120006

2008127304051 001

YANUAR MAULANA CAESAR KUNCORO

ANAK

13/01/2012

CISADEA

1,225 0002218875401 3517152403780002

2011017803241 001

NURHIDAYAT

PESERTA

24/03/1978

DINOYO

1,226 0002218875862 3524186810870002

2011017803241 001

USWATUN HASANAH

ISTRI

28/10/1987

DINOYO

1,227 0002218876299 3524184208120001

2011017803241 001

KAYLA AZKIYA AR ROYYANI

ANAK

02/08/2012

DINOYO

1,228 0002218877741 3506090510860002

feb018

YUDHISTIRA ARIE JATMIKA

PESERTA

05/10/1986

DINOYO

1,229 0002218878472 3573056102140003

feb018

ALIKA QAIREENA AZZAHRA

ANAK

21/02/2014

DINOYO

1,230 0002218878292 3507225402870002

feb026

ARI KUSUMA WARDANI

PESERTA

14/02/1987

DINOYO

1,231 0002218881159 3573026803900002

feb019

MAYA RESTU SHEILA PRAMESWARI

PESERTA

28/03/1990


1,232 0002218881205 3573012412840004

2012058412242 101

ALFAN MARIYANTO

PESERTA

24/12/1984


1,233 0002218881431 3579035301870005

2012058412242 101

SUWARNI

ISTRI

13/01/1987


1,234 0002218881587 3573014507120006

2012058412242 101

MEILA RAHMA AINUN NISA

ANAK

05/07/2012


1,235 0002218881756 3573016304140002

2012058412242 101

AQIRA ZAHRA BUNGA HAFIZAH

ANAK

23/04/2014


1,236 0002218882882 3507225405810007

feb020

AINUN NIKMAH

PESERTA

14/05/1981

PUSKESMAS DAU

1/31/17 4:02 PM

Page 70 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,237 0002218883185 3507220206830002

feb020

FAJAR JUNI A

SUAMI

02/06/1983

PUSKESMAS DAU

1,238 0002218883253 3507225605080002

feb020

ZAHRATUS SHITA AZWA

ANAK

16/05/2008

PUSKESMAS DAU

1,239 0002218883354 3507226408100002

feb020

THALITA HASNA QONITA

ANAK

24/08/2010

PUSKESMAS DAU

1,240 0002218884761 3573054710790006

feb021

ZULFA IKHSANIA

PESERTA

07/10/1979


1,241 0002218884985 3573055512850005

8412150822090 9

FRANSISKA PUSPITANINGTYAS

PESERTA

15/12/1985


1,242 0002218887189 3573041908830014

feb022

AGUS WIDODO

PESERTA

19/08/1983

DINOYO

1,243 0002218888541 3573010310850003

2012068510032 101

NANDA GALIH ARDANA

PESERTA

03/10/1985

CISADEA

1,244 0002218889057 3506266604860003

2012068510032 101

LIZA NURLAILI

ISTRI

26/04/1986

CISADEA

1,245 0002218889474 3507232511880001

2012028811251 001

YUDHA PRAWIRA SUPRAPTO

PESERTA

25/11/1988


1,246 0002218891285 3573024808890002

feb024

END SARIFAH AGUSTININGRUM

PESERTA

08/08/1989

ARJUNO

1,247 0002218891432 3573042807890004

feb024

TEGUH RISKIAWAN

SUAMI

28/07/1989

ARJUNO

1,248 0002218891454 3507224107880002

2012088807012 201

ANIK YULIANI

PESERTA

01/07/1988

PUSKESMAS DAU

1,249 0002218892229 3573042312870006

2012088807012 201

INDRA KURNIA PRATAMA

SUAMI

23/12/1987

PUSKESMAS DAU

1,250 0002218892411 3507222403140001

2012088807012 201

MARYAM FAQIHA

ANAK

24/03/2014

PUSKESMAS DAU

1,251 0002218891498 3507180308870007

2012098708031 001

AGUS ZUHDI AMRULLOH

PESERTA

03/08/1987


1,252 0002218891713 3507221505800004

6735462918729 729

KRISNAWI

PESERTA

15/05/1980


1,253 0002218892084 3573056704820006

6735462918729 729

SITI KHAMIDAH

ISTRI

27/04/1982


1,254 0002218892545 3507221903100001

6735462918729 729

ADZKA DHAKIY ALFARIZQI

ANAK

19/03/2010


1/31/17 4:02 PM

Page 71 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,255 0002218894323 3507225504120001

6735462918729 729

hilwana fahmara zahira

ANAK

15/04/2012


1,256 0002218892635 3507222509880004

feb025

DINAR WIDHIWASA

PESERTA

25/09/1988

KEDUNG KANDANG

1,257 0002218892861 3318140510800001

2010078010051 001

MIYADI

PESERTA

05/10/1980

ARJUNO

1,258 0002218893333 3573026601860002

2010078010051 001

SUCI DWI ARIANI

ISTRI

26/01/1986

ARJUNO

1,259 0002218893546 3573024401120002

2010078010051 001

PUTRI INAYA FATUROHMA

ANAK

04/01/2012

ARJUNO

1,260 0002218896663 3573025202130002

2010078010051 001

NASYA AYUDYA INARA

ANAK

12/02/2013

ARJUNO

1,261 0002218895515 3573052711780009

feb027

YUSUF BAKHRUDIN AMD

PESERTA

27/11/1978

KENDALSARI

1,262 0002218895673 3573056211760002

feb027

DINA NOVITASARI, SPD.

ISTRI

22/11/1976

KENDALSARI

1,263 0002218895829 3573057010060002

feb027

NAISYLA ZAHRA ANNISA

ANAK

30/10/2006

KENDALSARI

1,264 0002218895987 3573056801090007

feb027

REYNA BEBY CALLYSTA

ANAK

28/01/2009

KENDALSARI

1,265 0002218899295 3573043103830001

2004078303310 01

NOR HUDA

PESERTA

31/03/1983

JANTI

1,266 0002218899543 3573046802850009

2004078303310 01

NURUL SITI RAHAYU

ISTRI

28/02/1985

JANTI

1,267 0002218899791 3573041509080005

2004078303310 01

FRIZAS RAMADHAN MAULANA ANAK

15/09/2008

JANTI

1,268 0002218899982 3573041707120004

2004078303310 01

NOEL OMAR MUNISHER SHALEH

ANAK

17/07/2012

JANTI

1,269 0002218902603 3573052505810005

2010078105251 001

LUKMAN HIDAYAT, ST

PESERTA

25/05/1981

KENDALSARI

1,270 0002218902873 3573054903860005

2010078105251 001

MALISA CORY WARDANI, S.GZ ISTRI

09/03/1986

KENDALSARI

1,271 0002218903187 3573051203100006

2010078105251 001

SULTHAN DAFFA ASHSHOFWAN HIDAYAT

ANAK

12/03/2010

KENDALSARI

1,272 0002218905371 3573040202810008

2012028102021 01

YOHANES SETIAWAN

PESERTA

02/02/1981


1/31/17 4:02 PM

Page 72 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,273 0001826874246 3573026912880001

2012028102021 01

DINA SUSILOWATI

ISTRI

29/12/1988


1,274 0002218905977 3573030103820005

2009038203011 001

RIZKI TRISNADI

PESERTA

01/03/1982

PANDANWANGI

1,275 0002218907158 3522155004830001

2009038203011 001

DEWI KARTIKASARI B.

ISTRI

10/04/1983

PANDANWANGI

1,276 0002218907946 3573011903740001

7403190821055 5

GUNAWAN WIDI ISMARDIANTO PESERTA

19/03/1974


1,277 0002218908868 3507185408830005

7403190821055 5

PURWATI

ISTRI

17/08/1983


1,278 0002218909779 3507181504110002

7403190821055 5

MIR'AD AZIZ GUNAWAN

ANAK

15/04/2011


1,279 0002218909386 3507235701870001

2014018701012 001

SITI ABDIANI MASNUNAH

PESERTA

17/01/1987

KLINIK SEHAT

1,280 0002218909432 3573035106870009

2009128706112 001

ELISA TRIFANI SOBIRINA

PESERTA

11/06/1987


1,281 0002218910411 3573021111780001

2008127811111 011

SUGENG AKBARI

PESERTA

11/11/1978

ARJUNO

1,282 0002218910591 3573026611860006

2008127811111 011

MEGA YANTI

ISTRI

26/11/1986

ARJUNO

1,283 0002218910725 3573027006060004

2008127811111 011

JASMINE SUKMA ISLAMI

ANAK

30/06/2006

ARJUNO

1,284 0002218910861 3573025807070002

2008127811111 011

LARASHATI TORIQO ISLAMI

ANAK

18/07/2007

ARJUNO

1,285 0002218911063 3573025003100003

2008127811111 011

TAWANG KINANTI ISLAMI

ANAK

10/03/2010

ARJUNO

1,286 0002218910444 3519105101810001

2012088101112 001

YUDI ARIMBA WANI

PESERTA

11/01/1981


1,287 0002218911377 3507146701870002

2009287012720 01

SILFIA ASTRIANI

PESERTA

27/01/1987


1,288 0002218911737 3506172204800003

2009287012720 01

IMAM DAELAMI

SUAMI

22/04/1980


1/31/17 4:02 PM

Page 73 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,289 0002218912986 3510151405850001

2010088505142 101

YUSRON YOGATAMA, ST

PESERTA

14/05/1985

DINOYO

1,290 0002218913324 3510165203860004

2010088505142 101

RIA RISKI IRIANI

ISTRI

12/03/1986

DINOYO

1,291 0002218913559 3510155510130002

2010088505142 101

NADASIFA AYURISKI SHALIHA ANAK

15/10/2013

DINOYO

1,292 0002218913414 3516176804880007

2010018804282 001

KUSMIATI

PESERTA

28/04/1988


1,293 0002218916092 3573050602130002

2010018804282 001

ANDIKA MAHARDIKA MAHESWARA

ANAK

06/02/2013


1,294 0002218914639 3573050808830011

2009068308061 001

AGUSTYA PRIMADIANTA, S.KOM.

PESERTA

06/08/1983

KENDALSARI

1,295 0002218915359 3573016003830006

2012058303212 201

RISTIKA KURNIA NESTIORINI

PESERTA

20/03/1983

KENDALSARI

1,296 0002218915798 3573016802750007

1613/un10/kp20 15

NI LUH PUTU HERLI MASTUTI

PESERTA

28/02/1975


1,297 0002218915697 3573012203710005

1613/un10/kp20 15

MARTINUS TRIYOGA ANDRIANTO

SUAMI

22/03/1971


1,298 0002218917611 3573011901020007

1613/un10/kp20 15

WAYAN ENERO ANDRIANTO PUTRA

ANAK

19/01/2002


1,299 0002218918149 3573011207040002

1613/un10/kp20 15

KADEK ROLAVITO ANDRIANTO ANAK PUTRA

12/07/2004


1,300 0002218918781 3573012106090004

1613/un10/kp20 15

NYOMAN ALVARO ANDRIANTO ANAK PUTRA

21/06/2009


1,301 0002218916788 3573052105810019

2012018105211 01

FAHRUDIN RACHMAWAN SAPUTRA

PESERTA

21/05/1981

KENDALSARI

1,302 0002218917576 3573020404880001

2012058804041 001

VICKY AULIA RACHMAN

PESERTA

04/04/1988

ARJUNO

1,303 0002218918509 3507167105740002

331

DIAN WIDIYANTI

PESERTA

31/05/1974

TUMPANG

1,304 0002218921154 3573037001850008

8501301122051 4

RAHMA PUSPITASARI

PESERTA

30/01/1985


1,305 0002218922133 3573032811820005

8501301122051

ACHMAD FARIS

SUAMI

28/11/1982


1/31/17 4:02 PM

Page 74 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


4 1,306 0002218922357 3573030405080004

8501301122051 4

GHAISAN AHMAD ALTAMIS

ANAK

04/05/2008


1,307 0002218922651 3573031210090008

8501301122051 4

GIBRAN AHMAD RAMADHAN

ANAK

12/10/2009


1,308 0002218921413 3517090504790006

2001117904051 001

RATNO WAHYU WIDYANTO

PESERTA

05/04/1979

DINOYO

1,309 0002218920952 3517096809800001

2001117904051 001

LINDA ILFIANA MAHALESI

ISTRI

28/09/1980

DINOYO

1,310 0002218921558 3517096708060003

2001117904051 001

MAKAYLA ZANETTA WAHYU ARAFI

ANAK

27/08/2006

DINOYO

1,311 0002218921738 3507221107130002

2001117904051 001

MAKAYO VIRENDRA WAHYU ARAFI

ANAK

11/07/2013

DINOYO

1,312 0002218922098 3573051205770005

7705121321033 3

ZAINUL HADI

PESERTA

12/05/1977

DINOYO

1,313 0002218922234 3573055801770002

7705121321033 3

IDA HARIANTI

ISTRI

18/01/1977

DINOYO

1,314 0002218922425 3573052207020004

7705121321033 3

HAFIDZ NUR AT THORIQ

ANAK

22/07/2002

DINOYO

1,315 0002218922695 3573056210090004

7705121321033 3

HASNA ELSYADZA

ANAK

22/10/2009

DINOYO

1,316 0002218923044 3507072704670001

6704271321007 4

MUKHLIS SINALAHUDIN

PESERTA

27/04/1967

PONCOKUSUMO

1,317 0002218923281 3507074711740001

6704271321007 4

MUTMAINAH

ISTRI

07/11/1974

PONCOKUSUMO

1,318 0002218923371 3507070910960005

6704271321007 4

AJISAKTI PUTRO UTOMO

ANAK

09/10/1996

PONCOKUSUMO

1,319 0002218923538 3507077010080002

6704271321007 4

KHOIROTUL MAGHFIROH

ANAK

30/10/2008

PONCOKUSUMO

1,320 0002218924157 3573041211750002

2011117511121 01

JOKO IRAWAN

PESERTA

12/11/1975

JANTI

1,321 0002218924394 3573050510810005

303

EKO PURWANTO

PESERTA

05/10/1981

WAGIR

1/31/17 4:02 PM

Page 75 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,322 0002218924866 3573054701830004

303

YANIK KURNIASIH

ISTRI

07/01/1983

WAGIR

1,323 0002218925204 3573056807100002

303

FARAH NUR AZIZAH

ANAK

28/07/2010

WAGIR

1,324 0002218925439 3507214109150001

303

ASYIFA NUR HABIBAH

ANAK

01/09/2015

WAGIR

1,325 0002218925081 3573046909840010

2012028409292 001

ANITA HERAWATI

PESERTA

29/09/1984

JANTI

1,326 0002218925891 3573056907840002

2009128407292 001

ELY KRISNAWATI

PESERTA

29/07/1984


1,327 0002218926238 3573051504820003

2009128407292 001

MUHAMMAD ISMAIL

SUAMI

15/04/1982


1,328 0002218926475 3573056904110002

2009128407292 001

ALYA SABRINA LARASATI

ANAK

29/04/2011


1,329 0002218927678 3524232805900006

2014059005281 001

FIRSADA BAHARI, S.A.P.

PESERTA

28/05/1990


1,330 0002218927792 3573042207780006

2009017807221 001

SUPARDI

PESERTA

22/07/1978

DINOYO

1,331 0002218928545 3573042312770013

2011117712231 01

CHRISTIAN

PESERTA

23/12/1977

DINOYO

1,332 0002218928872 3573045905820010

2011117712231 01

ARY WIDYA ASTUTIK

ISTRI

19/05/1982

DINOYO

1,333 0002218929028 3573041011060007

2011117712231 01

RIAN CHRISTIAWAN

ANAK

10/11/2006

DINOYO

1,334 0002218929186 3573046001120004

2011117712231 01

IRA CHRISTIANA

ANAK

20/01/2012

DINOYO

1,335 0002218929276 3573046001120005

2011117712231 01

RIA CHRISTIANA

ANAK

20/01/2012

DINOYO

1,336 0002218929107 3573020309860004

2011118609031 001

GREGORIUS AGUNG SEPTIANTO

PESERTA

03/09/1986

CISADEA

1,337 0002218929726 3573026104920004

2011118609031 001

GRACE CLARA KARTIKA

ISTRI

21/04/1992

CISADEA

1,338 0002218930031 3573024406120002

2011118609031 001

AUREA NASYA CLARINTA

ANAK

04/06/2012

CISADEA

1/31/17 4:02 PM

Page 76 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,339 0002218929535 3524084706840003

2012058406072 001

SHO'IROTUL HUKMAH

PESERTA

07/06/1984

PUSKESMAS DAU

1,340 0001260543159 3524080704840007

2012058406072 001

MOH. TAUFIQ

SUAMI

07/04/1984

RAMPAL CELAKET

1,341 0002218930312 3524082906100002

2012058406072 001

IBNU AQIL CHAIRUL AZZAM

ANAK

29/06/2010

PUSKESMAS DAU

1,342 0002218929579 3329152208840003

2010098408221 001

CASMEDI ANDI SANTOSO

PESERTA

22/08/1984


1,343 0002218929693 3329155606860001

2010098408221 001

EVA YUNITA TRISYANI

ISTRI

11/06/1986


1,344 0002218933113 3329151603150001

2010098408221 001

FAKHRIE ZHAFRAN ALKHAIRY ANAK

16/03/2015


1,345 0002218929974 3507245406860002

2014058606142 001

YUNIAR FITRIA SC

PESERTA

14/06/1986


1,346 0002218931649 3573045311850004

8511131322033 1

SENJA PUSPITA AYU

PESERTA

13/11/1985

JANTI

1,347 0002218932134 3573046912110003

8511131322033 1

PRINCESS SHAKIRA CINTA AMELIA

ANAK

29/12/2011

JANTI

1,348 0002218932191 3579032006860001

2013028606201 001

DODIK KURNIAWAN

PESERTA

20/06/1986

BEJI

1,349 0002218932336 3507035711900002

2013028606201 001

PUTRI DWI NOVILIA ARLITA

ISTRI

17/11/1990

BEJI

1,350 0002218932764 3509175906850002

2009018506192 001

FITRIA DEWI LISTIANI

PESERTA

19/06/1985

DINOYO

1,351 0002218933012 3573056812880003

2012058812282 001

NIA NOVIANA

PESERTA

28/12/1988

KENDALSARI

1,352 0002218933631 3516062907900001

2013029007291 001

MUHAMMAD QOMARUDDIN

PESERTA

29/07/1990


1,353 0002218933686 3515062801870001

2010078701281 001

MUCH FARUQ HABIBILLAH

PESERTA

28/01/1987

DINOYO

1,354 0000098393411 3515174608890004

2010078701281 001

DEVY AGUSTIN

ISTRI

06/08/1989

DINOYO

1/31/17 4:02 PM

Page 77 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,355 0002218934406 3515175702130002

2010078701281 001

DEFANDA ALUNA QUEISHA HABIBI

ANAK

17/01/2013

DINOYO

1,356 0002218934507 3575026811780002

8333UN10KP20 13

RINA WASTIKA

PESERTA

28/11/1978


1,357 0002218934654 3575021911770001

8333UN10KP20 13

AGUNG PRABOWO

SUAMI

19/11/1977


1,358 0002218934733 3575025704090002

8333UN10KP20 13

NAURA CANTIKA AZMI PRABOWO

ANAK

17/04/2009


1,359 0002218934531 3573016711910003

2014059111272 001

DINAR AYU NURWANI

PESERTA

27/11/1991


1,360 0002218934755 3573022207850001

2011085072210 01

ALAN STEVRIE BALANTIMUHE, PESERTA ST

22/07/1985


1,361 0002218934834 3573055104860002

2011085072210 01

RICHE AVIANTY

ISTRI

11/04/1986


1,362 0002218934867 3573053009100005

2011085072210 01

EZEKHIEL PUTRA BALANTIMUHE

ANAK

30/09/2010


1,363 0002218934913 3573050707130003

2011085072210 01

EKLESIAS PUTRA BALANTIMUHE

ANAK

07/07/2013


1,364 0002218934823 3518035909810003

2013028109192 001

HERMIN KUSUMANINGSIH

PESERTA

19/09/1981

CISADEA

1,365 0002218935699 3573022506820006

2006018603272 001

DWI JOKO PRAWONO

PESERTA

25/06/1982

BARENG

1,366 0002218935824 3573025306080001

2006018603272 001

TALITHA SALSABILA ARTANTI ANAK

13/06/2008

BARENG

1,367 0002218935925 3573020908110002

2006018603272 001

MUHAMMAD DZAKI RIDO RAMADHAN

ANAK

09/08/2011

BARENG

1,368 0002218935791 3525145004860003

2010078604102 001

KUSNIA, A.MD.

PESERTA

10/04/1986

KENDALSARI

1,369 0002218935892 3518110708880004

2010078604102 001

ADITYA WIDIANTO

SUAMI

07/08/1988

KENDALSARI

1,370 0002218935969 3518115610140002

2010078604102 001

SALSABILA BALQIS WIDIANTO ANAK

16/10/2014

KENDALSARI

1/31/17 4:02 PM

Page 78 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,371 0002218936004 3573055805160001

2010078604102 001

AQUEENZA AQILA WIDIANTO

ANAK

18/05/2016

KENDALSARI

1,372 0002218936274 3573046806800007

8006281122008 6

FIRA AMALIA

PESERTA

28/06/1980


1,373 0002218936342 3573042812080001

8006281122008 6

ROMAN IBRAHIMOVIC

ANAK

28/12/2008


1,374 0002218936397 3573021609790006

2009017909161 001

FACHRUL DENNY KURNIAWAN PESERTA

16/09/1979

SINGOSARI

1,375 0002218936509 3573026511830007

2009017909161 001

HARINTINA

ISTRI

25/11/1983

SINGOSARI

1,376 0002218936555 3573022702070002

2009017909161 001

MUHAMMAD REIHAN.F

ANAK

27/02/2007

SINGOSARI

1,377 0002218937365 3573051705900001

2014089005172 101

REZAVANI FAHRULLOH

PESERTA

17/05/1990

DINOYO

1,378 0002218937556 3506255502870001

2012048702152 001

CHOIRUNIL CHOTIMAH

PESERTA

15/02/1987

DINOYO

1,379 0002218937872 3573040310860002

2010078610031 001

ANDI PRATOMO WIYONO,ST, MM.

PESERTA

03/10/1986

JANTI

1,380 0002218937938 3578046708890006

2010078610031 001

DYTA LOVERITA

ISTRI

27/08/1989

JANTI

1,381 0002218938298 3573055609800009

2008038009162 001

SUSRINI

PESERTA

16/09/1980

KENDALSARI

1,382 0002218938401 3573051506700005

2008038009162 001

AHMAD DENY

SUAMI

15/04/1974

KENDALSARI

1,383 0002218938805 3573054211000003

2008038009162 001

RARA ROSALIA MAGDARETA

ANAK

02/11/2000

KENDALSARI

1,384 0002218938557 3573056402780003

200907780

MESHIA OFFISINIRA

PESERTA

24/02/1978

KENDALSARI

1,385 0002218938671 3573056109060005

200907780

ALYA NABILA RAMADHANI

ANAK

21/09/2006

KENDALSARI

1,386 0002218938669 3573054903840005

2007018403092 001

SUBIYANTI EKASARI, SE, MM.

PESERTA

09/03/1984

MOJOLANGU

1,387 0002218938759 3573031901750003

2007018403092 001

HERMAN LUKITO INDRAJATI

SUAMI

19/01/1975

MOJOLANGU

1/31/17 4:02 PM

Page 79 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,388 0002218938941 3507240710810001

2009128110071 001

NURUDDIN ADHIYANTO

PESERTA

07/10/1981


1,389 0002218939042 3573056511860002

2009128110071 001

NOVI RATRININGTYAS

ISTRI

25/11/1986


1,390 0002218939176 3573053012110005

2009128110071 001

MUHAMMAD AZKA XAVIERO

ANAK

30/12/2011


1,391 0002218939277 3573051505150003

2009128110071 001

MUHAMMAD ARSA HAIDAR ALKHALIFI

ANAK

15/05/2015


1,392 0002218939367 3576020512840001

2014048412052 001

WAVA AKHIRTA PUTRA

PESERTA

05/12/1984

DINOYO

1,393 0002218939435 3576026906840002

2014048412052 001

RESTU PUSPITASARI

ISTRI

29/06/1984

DINOYO

1,394 0002218939479 3576026103120001

2014048412052 001

NAIFAH NURUL HUSNA

ANAK

21/03/2012

DINOYO

1,395 0002218939604 3518041806890003

2013038906181 001

ANDRIAS GIGIH SAPUTRA

PESERTA

18/06/1989

KENDALSARI

1,396 0002218939885 3519140812850002

2010078512081 011

IRFAN ANDI SAPUTRO

PESERTA

08/12/1985

DINOYO

1,397 0002218940043 3573052112830005

2014048312212 100

AHMAD SATRIA VERY SU'AIDI PESERTA

21/12/1983

DINOYO

1,398 0001792234078 3573024202900001

2014048312212 100

MARIA ULFA

ISTRI

02/02/1990


1,399 0002218940414 3573050401160004

2014048312212 100

MUHAMMAD ALFAREZI ALDEN ANAK ALEXEI

04/01/2016

DINOYO

1,400 0002218940188 3507130110820007

2007068210011 001

MUHAMMAD KHOIRUL HUDA

PESERTA

01/10/1982


1,401 0002218940245 3573045704930006

2007068210011 001

ROSI NOVITA SARI

ISTRI

17/04/1993


1,402 0002218940302 3573010605810008

2010078105061 001

RONNY SETIANTOKO

PESERTA

06/05/1981


1,403 0002218940717 3305041307880001

2014048807132 101

AHMAD NASICHUDIN

PESERTA

13/07/1988

PAGELARAN

1/31/17 4:02 PM

Page 80 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,404 0000110503539 3507336810910001

2014048807132 101

NURI ARDIANTI

ISTRI

28/10/1991

PAGELARAN

1,405 0002218940741 3505172402850002

1011048502241 001

PONDA WISNU PRIBADI

PESERTA

24/02/1985


1,406 0002218940818 3519045410850002

1011048502241 001

ASFIANI FARIDA

ISTRI

14/10/1985


1,407 0002218940842 3505172406120003

1011048502241 001

RAHADIAN ANANTA WISNUPUTRA

ANAK

24/06/2012


1,408 0002218940853 3505176204140001

1011048502241 001

CHALYA ADWITYA WISNUWARDHANI

ANAK

22/04/2014


1,409 0002218941022 3573052108850010

2011048508211 001

INDRA KURNIAWAN SUSILO

PESERTA

21/08/1985

MULYOREJO

1,410 0002218941112 3573052608820004

2009108208262 100

SUNARKO

PESERTA

26/08/1982


1,411 0002218941224 3507167005840002

2009108208262 100

FITRIA FARITA

ISTRI

30/05/1984


1,412 0002218941415 3507166402140001

2009108208262 100

ALYA KHAIRINA PUTRI

ANAK

24/02/2014


1,413 0002218941303 3508122209820002

8209221321000 1

JEDIK KURNIAWAN

PESERTA

22/09/1982

KENDALSARI

1,414 0002218941742 3507132104820004

8204211321039 4

LUTFI HARI WAHYUDI

PESERTA

21/04/1982


1,415 0002218941832 3579036407890001

2014068907242 001

TRI NATA NUR AIJA

PESERTA

24/07/1989

JUNREJO

1,416 0002218942203 3573050604850009

2008128504061 001

DWI PRIANTORO

PESERTA

06/04/1985


1,417 0002218942293 3573054104820003

2008128504061 001

DWI INDAH LESTARI

ISTRI

01/04/1982


1,418 0002218942337 3573051208060006

2008128504061 001

NAFFI SURYA ANDIKA

ANAK

12/08/2006


1,419 0002218942359 3579030107150003

2008128504061 001

SYAHRIZAL HASHIF RAMADHAN

ANAK

01/07/2015


1/31/17 4:02 PM

Page 81 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,420 0002218943259 3573056508840011

2009038408252 001

CUCUK ANGGRAENI

PESERTA

25/08/1984

MOJOLANGU

1,421 0002218943294 3573051806850006

2009038408252 001

WAHYU RAKHMADHANI

SUAMI

18/06/1985

MOJOLANGU

1,422 0002218943305 3573055112100004

2009038408252 001

SHALVYNE MAR'AH SYARIFAH ANAK

11/12/2010

MOJOLANGU

1,423 0002218943362 3573052712130002

2009038408252 001

KELVIN MAULANA AQUERO

ANAK

27/12/2013

MOJOLANGU

1,424 0002218943349 3516151902830002

2013108302191 001

HENDRI SUDARMAJI

PESERTA

19/02/1983


1,425 0001453949886 3516155002810006

2013108302191 001

LINAWATI

ISTRI

10/02/1981

KEMLAGI

1,426 0002218943439 3516155607100002

2013108302191 001

GRACIA ANANTA SHEILA ASMARANDA

ANAK

16/07/2010


1,427 0002218943474 3516156002150001

2013108302191 001

FANNY ELVINA ASMARANDA

ANAK

20/02/2015


1,428 0002218943709 3573036402770007

2008027702242 001

DESI KAFA NILLA, SE

PESERTA

24/02/1977

KEDUNG KANDANG

1,429 0002218943777 3573023001770004

2008027702242 001

MUHAMMAD SAIFUL ANWAR SE

SUAMI

30/01/1977

KEDUNG KANDANG

1,430 0002218943979 3573031503100006

2008027702242 001

MUHAMMAD KHALIEF DAVIN SAIFKAFA ARASY

ANAK

15/03/2010

KEDUNG KANDANG

1,431 0002218944014 3573031904120004

2008027702242 001

MUHAMMAD IBRAHIM KHAIRAN SAIFKAFA ARASY

ANAK

19/04/2012

KEDUNG KANDANG

1,432 0002218944306 3573051711830002

8311171321037 5

HANDRI MUKTI SUDARSONO

PESERTA

17/11/1983

KENDALSARI

1,433 0002218944341 3573054401830005

8311171321037 5

SUSIYANTI

ISTRI

04/01/1983

KENDALSARI

1,434 0002218944385 3573056412100001

8311171321037 5

QUEENSHA NAYANA ABHIKHYA PUTRI SUDARSONO

ANAK

24/12/2010

KENDALSARI

1,435 0002218944442 3573050912150001

8311171321037 5

MUHAMMAD AZKA ATHAYA PUTRA SUDARSONO

ANAK

09/12/2015

KENDALSARI

1/31/17 4:02 PM

Page 82 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,436 0002218944791 3507106008920002

2012129208202 001

LAILATUL FITRIYA

PESERTA

20/08/1992

KETAWANG

1,437 0002218944936 3573031104770007

2007077704111 001

TUNGGUL LAKSONO

PESERTA

11/04/1977

KLINIK ELISA

1,438 0002218945094 3573037010770002

2007077704111 001

SRI HARIYANI

ISTRI

30/10/1977

KLINIK ELISA

1,439 0002218945375 3573035201070005

2007077704111 001

SONIA ANJAR KINARSIH

ANAK

12/01/2007

KLINIK ELISA

1,440 0002218945421 3573037004080008

2007077704111 001

PUTRI MARSYA JATAYU

ANAK

30/04/2008

KLINIK ELISA

1,441 0002218945072 3579036409860002

2011108609242 001

DWI RAHAYUNINGSIH

PESERTA

24/09/1986

JUNREJO

1,442 0002218945419 3573021709890003

2011078909171 001

MAS ADIM

PESERTA

17/09/1989

ARJUNO

1,443 0002218945454 3573020101160001

2011078909171 001

YAFI AFFAN MAULANA

ANAK

01/01/2016

ARJUNO

1,444 0002218945792 3573050601820023

2009118201061 001

RUSTAMADJI MOHAMAD SAIKU

PESERTA

06/01/1982

KENDALSARI

1,445 0002218945825 3573056908860005

2009118201061 001

ANNA WIDYASIH

ISTRI

29/08/1986

KENDALSARI

1,446 0002218945858 3573052302070001

2009118201061 001

RIYANTO

ANAK

23/02/2007

KENDALSARI

1,447 0002218945904 3573056512070001

2009118201061 001

SYIVA WIDYA SAIKU

ANAK

25/12/2007

KENDALSARI

1,448 0002218945882 3573050411810001

8111040721011 5

NOVI ANDRIANTO

PESERTA

04/11/1981


1,449 0002218945961 3573055006840001

8111040721011 5

YETI PUJI LESTARI

ISTRI

10/06/1984


1,450 0002218946027 3573051508100001

8111040721011 5

BAHRIL HAMDAN ALI

ANAK

15/08/2010


1,451 0002218946141 3573050407150002

8111040721011 5

ARSAKHA VIRENDRA ALI

ANAK

04/07/2015


1/31/17 4:02 PM

Page 83 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,452 0002218946218 3573045902880001

2011088021920 01

RENI ANGGRAENI

PESERTA

19/02/1988

JANTI

1,453 0002218946692 3573044404810012

2011108104042 001

ANITA PUSPITA RINI

PESERTA

04/04/1981

JANTI

1,454 0002218946714 3573041112790008

2011108104042 001

SUKONYOTO PRASOJO

SUAMI

11/12/1979

JANTI

1,455 0002218946736 3573040401070002

2011108104042 001

DEWANANDA DAFFA PUTRA PRASOJO

ANAK

04/01/2007

JANTI

1,456 0002218946747 3573041501140002

2011108104042 001

RADITYA MAULANA PUTRA PRASOJO

ANAK

15/01/2014

JANTI

1,457 0002218947197 3573056004800003

8004201322037 8

A. SELVYA DIAN KARTIKASARI PESERTA

20/04/1980

KENDALSARI

1,458 0002218947322 3573052903100005

8004201322037 8

A. PUTRA TEGAR PRATAMA

ANAK

29/03/2010

KENDALSARI

1,459 0002218947434 3579012910790004

2006067910291 001

ARIE SUMYARDIANTO

PESERTA

29/10/1979

SISIR

1,460 0002218947489 3579016612780002

2006067910291 001

DINI DAMAYANTI

ISTRI

26/12/1978

SISIR

1,461 0002218947581 3579011010100001

2006067910291 001

ATHALLAH OKTAVIARDA ALRENESYACH

ANAK

10/10/2010

SISIR

1,462 0002218947636 3579016710150001

2006067910291 001

ATHIYYARAHMA OKTAVIARDA ANAK LIONA

27/10/2015

SISIR

1,463 0002218947603 3573056609820007

2011108209262 000

ANITA KHOIRUNISA

PESERTA

26/09/1982

KENDALSARI

1,464 0002218947658 3573052512840009

2011108209262 000

MUHAMMAD IQBAL

SUAMI

25/12/1984

KENDALSARI

1,465 0002218947963 3573052810820017

2006038210281 001

BENI KRISTIAN ALAMSYAH

PESERTA

28/10/1982

DINOYO

1,466 0002218948031 3573054508840002

2006038210281 001

INDAH RAHMAWATI

ISTRI

05/08/1984

DINOYO

1,467 0002218948119 3573054602110004

2006038210281 001

FIDELA ABIDAH HILARY

ANAK

06/02/2011

DINOYO

1/31/17 4:02 PM

Page 84 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,468 0002218948536 3573031909820010

2011118209191 001

WISNU PUTRA AJI WIJAYA

PESERTA

19/09/1982

BP WIRA HUSADA (AD)

1,469 0002218948738 3573046810920002

2011118209191 001

ANISA AYU RATNASARI

ISTRI

28/10/1992

BP WIRA HUSADA (AD)

1,470 0002218948751 3573045507110003

2011118209191 001

VANISA BILMY TSABITA QUEEN

ANAK

15/07/2011

BP WIRA HUSADA (AD)

1,471 0002218948863 3507182410860002

2005088610241 001

NUR FAUZI

PESERTA

24/10/1986

PAKIS

1,472 0002218948896 3507186509860005

2005088610241 001

ELOK KARTIKA SARI

ISTRI

25/09/1986

PAKIS

1,473 0002218948975 3507180405100002

2005088610241 001

FHAREZA ARGATAMA FAUZI

ANAK

04/05/2010

PAKIS

1,474 0002218949313 3573022605770003

2004107705261 001

EKO KUSWOYO

PESERTA

26/05/1977


1,475 0002218949357 3573025101820004

2004107705261 001

NURSITA

ISTRI

11/01/1982


1,476 0002218949381 3573020605040001

2004107705261 001

WAHYU MAULUDI MAHARDIKA ANAK

06/05/2004


1,477 0002218949605 3573021504780003

2008027804151 001

DENY SAFRELATENDRA ARIUS HARYANTO

PESERTA

15/04/1978

ARJUNO

1,478 0002218949651 3573026408790001

2008027804151 001

WIHARFITRI SUCININGRUM

ISTRI

24/08/1979

ARJUNO

1,479 0002218949739 3575020703850001

2012058503071 001

ISTOE PARDIKAJAYADI

PESERTA

07/03/1985

KEDUNG KANDANG

1,480 0002218949752 3520067105830001

2012058503071 001

DEWI MASITHOH

ISTRI

31/05/1983

KEDUNG KANDANG

1,481 0002218949897 3573024306890001

2012058906032 001

DWI PRATIWI NURJANAH

PESERTA

03/06/1989

KLINIK ELISA

1,482 0002218972702 3507224104900001

2012059004012 001

KIKI MEGA KRISTANTI

PESERTA

01/04/1990

PUSKESMAS DAU

1,483 0002218986483 3573054505810025

8105050722050 4

MELANI ANGGOROWATI

PESERTA

05/05/1981

KENDALSARI

1/31/17 4:02 PM

Page 85 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


SUAMI

20/10/1980

KENDALSARI

1,484 0002218986911 3573052010800013

8105050722050 4

ARIEF DWI HARTOKO KURNIAWAN

1,485 0002218992399 3573046004830002

8304200722005 4

HARDINI DRIYA KARUNAWATI PESERTA

20/04/1983

KLINIK ELISA

1,486 0002218993582 3510210503830002

8304200722005 4

YUDHA AROFAH SAPI'I

SUAMI

05/03/1983

KLINIK ELISA

1,487 0002218996798 3573045910880002

2010018810192 001

NUR FITRI OCTAVIA

PESERTA

19/10/1988

KENDALSARI

1,488 0002218997305 3573054803120004

2010018810192 001

RAFIKA KALLISTA BILQIS

ANAK

08/03/2012

KENDALSARI

1,489 0002219035296 3573014611830008

2008028311062 001

NINIK VERAWATY

PESERTA

06/11/1983


1,490 0002219036861 3573010204070003

2008028311062 001

M. HASBIALLAH UNWANUL FALAH HADI

ANAK

02/04/2007


1,491 0002219037399 3573010203110002

2008028311062 001

AHMAD GHOZIYUDDIN JUFRI NURIL HADI

ANAK

02/03/2011


1,492 0002219066469 3507236803790003

2013057903282 001

ASNAH HIDAYATI

PESERTA

28/03/1979

KARANG PLOSO

1,493 0002219067167 3507230212040003

2013057903282 001

FAKHRIZAL AKMAL ABDILLAH

ANAK

02/12/2004

KARANG PLOSO

1,494 0002219067472 3507236509080001

2013057903282 001

AISHA KAMEELA AGNIYA

ANAK

25/09/2008

KARANG PLOSO

1,495 0002219070846 3573031806770003

2005077706181 001

SATUMAN, S.Si. M.Kes

PESERTA

18/06/1977

KEDUNG KANDANG

1,496 0002219072398 3573036910750004

2005077706181 001

OKTAVIANA RATNA WARDHANI

ISTRI

29/10/1975

KEDUNG KANDANG

1,497 0002219079431 3573036006070001

2005077706181 001

CARISSA SALSABILA AS-SYIFA ANAK SAVITRI

20/06/2007

KEDUNG KANDANG

1,498 0002219079712 3573032009090002

2005077706181 001

ATHALLAH FADIL MUHAMMAD ANAK SAVITRA

20/09/2009

KEDUNG KANDANG

1,499 0002219080779 3573032111130004

2005077706181 001

ZABDAN ABID MUHAMMAD SAVITRA

21/11/2013

KEDUNG KANDANG

1/31/17 4:02 PM

ANAK

Page 86 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,500 0002219188702 3573025001860007

2010018611022 001

ELLY YANUARTININGSIH

PESERTA

10/01/1986

ARJOWINANGUN

1,501 0002219189398 3507191301840001

2010018611022 001

LUCKY KRISTIAWAN

SUAMI

13/01/1984

ARJOWINANGUN

1,502 0002219189512 3507191112110001

2010018611022 001

FAEYZA RAVIDYANDRA KRISTIAWAN

ANAK

11/12/2011

ARJOWINANGUN

1,503 0002219190513 3503080412820002

2011118212041 001

HARIS KRIDHO WINOTO

PESERTA

04/12/1982

DINOYO

1,504 0002219190671 3577017006830002

2011118212041 001

KARTIKA SARI PURBAYANI

ISTRI

30/06/1983

DINOYO

1,505 0002219190851 3577014106110002

2011118212041 001

NABILA AMALIA ZAHRAFANI

ANAK

01/06/2011

DINOYO

1,506 0002219192144 3506193006830002

2008028306301 001

BUDI WICAKSONO

PESERTA

30/06/1983

SINGOSARI

1,507 0002219192728 3506196209840001

2008028306301 001

NURISA ARUM WULANSARI

ISTRI

22/09/1984

SINGOSARI

1,508 0002219193213 3509161211110004

2008028306301 001

arfa aqila syahran

ANAK

12/11/2011

SINGOSARI

1,509 0002219195619 3573030207830001

2010830702100 1

RAMDHANI LUQMAN NUGROHO

PESERTA

02/07/1983

KEDUNG KANDANG

1,510 0000107161323 3504057010870002

2010830702100 1

EMA ARGIANTI

ISTRI

30/10/1987

KEDUNG KANDANG

1,511 0002219207049 3573034506130005

2010830702100 1

NAURA NAQIYYAH SALSABILA ANAK

05/06/2013

KEDUNG KANDANG

1,512 0002219200683 3573032504820001

2007038204251 001

ARY KURNIAWAN

PESERTA

25/04/1982

KEDUNG KANDANG

1,513 0002219200964 3573036702880010

2007038204251 001

INDRI JUNIS PRAMISTI PRIBADI

ISTRI

27/02/1988

KEDUNG KANDANG

1,514 0002219210932 3573056305890005

2011118905232 001

VINA MEKA SARI

PESERTA

23/05/1989

DINOYO

1,515 0002219212236 3573021404780005

2006037804141 001

AGUS FIRMANSYAH

PESERTA

14/04/1978

ARJUNO

1/31/17 4:02 PM

Page 87 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,516 0002219212811 3573025511860008

2006037804141 001

ERMA HARIANI

ISTRI

15/11/1986

ARJUNO

1,517 0002219213777 3573024111060003

2006037804141 001

ARGES TAZHARUS RIYADINA FITRIANSYAH

ANAK

01/11/2006

ARJUNO

1,518 0002219216949 3573021606090001

2006037804141 001

rafie zakysufi firmansyah

ANAK

16/06/2009

ARJUNO

1,519 0002219214227 3573050503770003

2008027703051 001

KUNCORO ADI PURNOMO

PESERTA

05/03/1977

dr. AMAN TEGUH P. (JST)

1,520 0002219217388 3507153011880001

2011118811301 001

MUHAMMAD ANANG MUSTHOFA

PESERTA

30/11/1988

TAJINAN

1,521 0002219221372 3573056205870004

2012058705222 001

INDAH WULANDARI

PESERTA

22/05/1987

KENDALSARI

1,522 0002219227593 3573046203830002

2011118303222 001

SUCI MEGASARI

PESERTA

22/03/1983

KLINIK RAWAT JALAN DELTA

1,523 0002219232126 5201147003840001

2011118403302 001

TARINA WIDANINGRUM

PESERTA

30/03/1984

ARJUNO

1,524 0002219233026 3505030608830002

2013078308062 100

RENDRA WIRAWAN

PESERTA

06/08/1983

DINOYO

1,525 0002219233588 3510225310880002

2013078308062 100

IKRAR DESIANA EMA YUNITA

ISTRI

13/10/1988

DINOYO

1,526 0002219233735 3505036808120001

2013078308062 100

NAURA ATHAYYA TAZKIYA

ANAK

28/08/2012

DINOYO

1,527 0002219236604 3507246201830002

3507246201830 002

FARAH DILLAH

PESERTA

22/01/1983

FARIDA RUSNIANAH, dr

1,528 0002219237638 3507244911070005

3507246201830 002

ELLEANORE PUTRI FEYLQULAIBAH

ANAK

09/11/2007

FARIDA RUSNIANAH, dr

1,529 0002219237144 3573035709750002

2008027509172 001

PUPUN HARSASI

PESERTA

17/09/1975

KEDUNG KANDANG

1,530 0002219237515 3573031612760003

2008027509172 001

MAWARDE PRAJA

SUAMI

16/12/1976

KEDUNG KANDANG

1,531 0002219237662 3573030608030002

2008027509172 001

HUDAN EZRA'ALANA PRAJA

ANAK

06/08/2003

KEDUNG KANDANG

1/31/17 4:02 PM

Page 88 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,532 0002219237842 3573032508090002

2008027509172 001

SAKHA SADIIDAA PRAJA

ANAK

25/08/2009

KEDUNG KANDANG

1,533 0002219238009 3573031105120003

2008027509172 001

KHALIFANDHRA AZIZAN PRAJA

ANAK

11/05/2012

KEDUNG KANDANG

1,534 0002219239506 3573024401790003

2008027901042 001

PRIMASARI YANUASRI

PESERTA

04/01/1979


1,535 0002219241082 3578021407870002

2008027901042 001

aji selamet

SUAMI

14/06/1987


1,536 0002219241947 3573022803010001

2008027901042 001

PRAYOGO BANGUN TEGAR SUNARYO PUTRA

ANAK

28/03/2001


1,537 0002219244682 3507216509830002

2011118309252 001

FETY CITRA AYU NIVEA

PESERTA

25/09/1983

WAGIR

1,538 0002219244963 3507211607840001

2011118309252 001

SATRIYO YULIANTO

SUAMI

16/07/1984

WAGIR

1,539 0002219245097 3507211807080001

2011118309252 001

FATTAH AFIQ ABDURRAHMAN ANAK

18/07/2008

WAGIR

1,540 0002219246818 3573044608830012

2006068308062 001

DIYAH CATURINI

PESERTA

06/08/1983

SINGOSARI

1,541 0002219247033 3507243110820002

2006068308062 001

DIDIK OKTARIYANTO

SUAMI

31/10/1982

SINGOSARI

1,542 0002219247246 3507242002100002

2006068308062 001

ALMER DZAKY PRATAMA

ANAK

20/02/2010

SINGOSARI

1,543 0002219247314 3507240603130003

2006068308062 001

AZKA AINNUR RADITYA

ANAK

06/03/2013

SINGOSARI

1,544 0002219251972 3573032404770003

2007017704241 001

WAHYU MUJI ISWANTO

PESERTA

24/04/1977

KEDUNG KANDANG

1,545 0002219258158 3573030607880003

2010018807067 001

IMAM WAHYU INDRAWAN

PESERTA

06/07/1988

ARJOWINANGUN

1,546 0002219261253 3573036403770003

2010017703242 001

YULASTIN LESTARI, A.MD.

PESERTA

24/03/1977

PUSKESMAS DAU

1,547 0002219263211 3573031308780004

2010017703242 001

DIDIK HARTONOS.S., M.PD.

SUAMI

13/08/1978

PUSKESMAS DAU

1/31/17 4:02 PM

Page 89 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,548 0002219267406 3573016701850004

2011118501272 001

DINI SURYANING MENTARI

PESERTA

27/01/1985


1,549 0002219269792 3573011901810011

2011118101191 001

KUSWINDARTO

PESERTA

19/01/1981


1,550 0002219270106 3573015306870006

2011118101191 001

FITRIANA YUNI PERMANA SARI

ISTRI

13/06/1987


1,551 0002219303125 3573041109840006

2008028409111 001

OKKY ANDRIANTO, ST

PESERTA

11/09/1984

JANTI

1,552 0002219414692 3573045908850008

2008028409111 001

ELIA AGUSTINA SUGIANTI

ISTRI

19/08/1985

JANTI

1,553 0002219414815 3573042112090003

2008028409111 001

MUHAMMAD DAFFA PUTRA ANDRIANTO

ANAK

21/12/2009

JANTI

1,554 0002219414883 3573041706110001

2008028409111 001

MUHAMMAD ALVANO ANDRIANTO

ANAK

17/06/2011

JANTI

1,555 0002219318594 3507293004900002

00205105200

SUCIPTO

PESERTA

30/04/1990


1,556 0002219318831 3507294811920005

00205105200

DIYAH RESTU UTAMI

ISTRI

08/11/1992


1,557 0002219319224 3507292611140001

00205105200

FATAHILLAH DANISH CIPTANA ANAK

26/11/2014


1,558 0002219348698 3525125501860003

3573032101160 013

ZAHRIN HAMIDIANA, S.PI

PESERTA

15/01/1986

GRIBIG

1,559 0002219349115 3525121107850001

3573032101160 013

IN'AMUL WAFI, S.PDI

SUAMI

11/07/1985

GRIBIG

1,560 0002219353536 3507132008740005

2011037408201 001

AGUS SUSILO

PESERTA

20/08/1974

KEPANJEN

1,561 0002219353683 3507136607800003

2011037408201 001

ENDAH SUSILOWATI

ISTRI

26/07/1980

KEPANJEN

1,562 0002219353975 3507130403100004

2011037408201 001

ARJUNA GHANY RIZKY PUTRA ANAK S

04/03/2010

KEPANJEN

1,563 0002219354278 3507130711150002

2011037408201 001

ARUNA KIRANA FIRDAUS PUTRA S

ANAK

07/11/2015

KEPANJEN

1,564 0002219427562 3573014205790002

2011117905022 001

ELISA IRAWATI

PESERTA

02/05/1980

PANDANWANGI

1/31/17 4:02 PM

Page 90 of 91


No. Kartu

NIK

NIP. Lama

NIP. Baru

Nama

Hub. Keluarga


1,565 0002219428293 3573021210830003

2011117905022 001

ROBBY CAHYONO

SUAMI

12/10/1983

PANDANWANGI

1,566 0002219447384 3578166504850002

2011118504252 200

SRI AUSTRIANI

PESERTA

25/04/1985

DINOYO

1,567 0002219461896 3573056804860005

2012058604282 200

HENY KURNIAWATI, SE.

PESERTA

28/04/1986

DINOYO

1,568 0002219463663 3507224102860004

2012058602012 200

SUSILAWATI

PESERTA

01/02/1986

PUSKESMAS DAU

1,569 0002219465349 3573044909870002

2012058709092 200

HARISAH RAHMAWATI

PESERTA

09/09/1987

JANTI

1,570 0002219466521 3573052801900002

2010019001281 001

KUSWARA MUADJIR NUIN

PESERTA

28/01/1990

DINOYO

1,571 0002219477499 3573026202880004

2011118802222 001

RITA MARGARETA CH

PESERTA

22/02/1988

ARJUNO

1,572 0002219481887 3573054611800003

2008028011062 001

TRIATIM NOVIYANTI

PESERTA

06/11/1980

DINOYO

1,573 0002219487838 3573051007860004

2011118607101 001

DIMAS PRAHASTO HADINUGROHO

PESERTA

10/07/1986

DINOYO

1,574 0002219489425 3507185412880003

2013038812142 200

FANNY ANDHINI PUTRI

PESERTA

14/12/1988

PAKIS

1/31/17 4:02 PM

Page 91 of 91

DAFTAR PESERTA PER SATUAN KERJA

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