Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4552 | AK |
N | 208D00000X | General Practice Physician | 4552 | AK |
NPI | 1013989797 |
---|---|
Provider Name | Stacey R Nieder |
First Address | Anchorage, AK 99508-4658 |
Second Address | Anchorage, AK 99508-4658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 19/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152556 | MCARE GROUP # (01) | AK |
G34578 | (02) | |
MD6185 | (05) | AK |