Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 166016 | AK |
NPI | 1023622370 |
---|---|
Provider Name | Ashley Suzanne Granath |
First Address | Palmer, AK 99645-7030 |
Second Address | Wasilla, AK 99654-7215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |