Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 11640 | AK |
NPI | 1023072832 |
---|---|
Provider Name | Patricia Mcdonald |
First Address | Anchorage, AK 99508-4615 |
Second Address | Anchorage, AK 99508-4615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP7688 | (05) | AK |
P51674 | (02) | AK |