Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 83 | AK |
NPI | 1003190646 |
---|---|
Provider Name | Suzette Marie Mailloux |
First Address | Fairbanks, AK 99709-5234 |
Second Address | Fairbanks, AK 99709-5234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2011 |
Last Update Date | 30/09/2011 |