Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | AA3070 | AK |
NPI | 1578608873 |
---|---|
Provider Name | Susan K. Fenn |
First Address | Anchorage, AK 99508-2953 |
Second Address | Anchorage, AK 99508-2953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PD3070 | (05) | AK |
T67014 | (02) | AK |