Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 118589 | AK |
NPI | 1073050373 |
---|---|
Provider Name | Brianna Clendenin |
First Address | Anchorage, AK 99503-2746 |
Second Address | Anchorage, AK 99503-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 23/06/2021 |