Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 110754 | AK |
N | 207Q00000X | Family Doctor | MRM-1323 | ID |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 110754 | AK |
NPI | 1720273667 |
---|---|
Provider Name | Kelsey Angeline Terland |
First Address | Corvallis, OR 97339-1188 |
Second Address | Anchorage, AK 99508-4615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1648721 | (05) | AK |