Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 152208 | AK |
NPI | 1972787281 |
---|---|
Provider Name | Andrea Forte |
First Address | Fairbanks, AK 99709-3552 |
Second Address | Fairbanks, AK 99709-3552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2007 |
Last Update Date | 21/12/2007 |