Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 18110007 |
NPI | 1083275671 |
---|---|
Provider Name | Susan Karleen Fisk |
First Address | Kenai, AK 99611-8818 |
Second Address | Kenai, AK 99611-8818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |