Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 248 | AK |
Y | 156FX1800X | Optician | AK248 | AK |
NPI | 1093920670 |
---|---|
Provider Name | Christi Lb Mcwilliams |
First Address | Fairbanks, AK 99701-1739 |
Second Address | Fairbanks, AK 99701-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DOPD248 | OCCUPATIONAL LICENSE (01) | AK |