Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A150609 | NM |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A150609 | NM |
NPI | 1336389360 |
---|---|
Provider Name | Mrs. Mindy Lynn Treybal |
First Address | Fairbanks, AK 99701-4948 |
Second Address | Fairbanks, AK 99701-4948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2009 |
Last Update Date | 02/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1630163 | (05) | AK |
FT1592523 | DEA (01) | AK |