Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 173700 | AK |
NPI | 1063917177 |
---|---|
Provider Name | Caitlin Justine Koelling |
First Address | Anchorage, AK 99508-5202 |
Second Address | Wasilla, AK 99654-7422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2018 |
Last Update Date | 19/08/2021 |