Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 36868 | AZ |
NPI | 1003095811 |
---|---|
Provider Name | Dr. Karen Louise Bramer-Fortier |
First Address | Whiteriver, AZ 85941-0860 |
Second Address | Whiteriver, AZ 85941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 03/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295993376 | (05) | AZ |
1427335140 | (05) | AZ |
1427335181 | (05) | AZ |
8HH086 | (02) | |
8HH087 | (02) |