Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 299 | AK |
NPI | 1013232305 |
---|---|
Provider Name | Angela Lynn Hawk |
First Address | Fairbanks, AK 99701-3006 |
Second Address | Fairbanks, AK 99701-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OP0004 | (05) | AK |