Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 166195 | AK |
NPI | 1003481177 |
---|---|
Provider Name | Mrs. Whitney Mcclintock |
First Address | Fairbanks, AK 99701-5907 |
Second Address | North Pole, AK 99705-7059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2021 |
Last Update Date | 21/05/2021 |