Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4986 | AK |
N | 207YP0228X | Pediatric Otolaryngology | 4986 | AK |
NPI | 1740299924 |
---|---|
Provider Name | Jennifer Wingate |
First Address | Anchorage, AK 99508-5051 |
Second Address | Anchorage, AK 99508-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F23635 | (02) | AK |
MD09191 | (05) | AK |