Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 134550 | AK |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 134550 | AK |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APN.0994028-NP | CO |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RXN.0103413-NP | CO |
NPI | 1043706245 |
---|---|
Provider Name | Susana Donofry |
First Address | Fairbanks, AK 99709-3687 |
Second Address | Fairbanks, AK 99709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 02/10/2018 |