Data Pribadi Mahasiswa Kepaniteraan Klinik Fk.docx

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DATA PRIBADI MAHASISWA KEPANITERAAN KLINIK FK.YARSI

1. NAMA LENGKAP 2. NPM

: ANDRIANA WIJAYA : 1102011027

3. JENIS KELAMIN

: LAKI – LAKI

4. TEMPAT / TANGGAL LAHIR

: BEKASI,22 SEPTEMBER 1993

5. ALAMAT LENGKAP

: jl. Menteng raya no.20 lippo cikarang

(1)

.………………………………………………………………………………… ALAMAT LENGKAP ORANG TUA (2 )

: jl. Menteng raya no.20 lippo cikarang …………………………………………………………………………………..

6. NO. TELP / HP YANG AKTIF

: 081286565553

7. ALAMAT EMAIL

: [email protected]

8. TGL, BULAN DAN TH LULUS S.KED

: …………………………………………………………………………………..

9. NAMA ORANG TUA ( AYAH )

: Omin Basuni

NAMA ORANG TUA ( IBU )

: Kokom Komalasari

10. NO. TLP ORANG TUA YG BISA DIHUBUNGI

: 08111994889

11. PEKERJAAN ORANG TUA ( AYAH )

: Wiraswasta

PEKERJAAN ORANG TUA ( IBU )

: Wiraswasta

Jakarta,

2018

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