Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 131171 | AK |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5315071478 | MI |
NPI | 1023492642 |
---|---|
Provider Name | Dr. Jennifer Ribar |
First Address | East Lansing, MI 48823-2386 |
Second Address | Fairbanks, AK 99701-4948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2015 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1684371 | (05) | AK |