Doctor Name: | AMANDA LOOMIS |
NPI Number: | 1003210030 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 1187 |
Business Practice Address: | 1867 Airport Way Suite 130b Fairbanks, AK - 997014054 |
Business Phone Number: | 9074522178 |
Business Fax Number: | |
Mailing Address: | 1867 Airport Way, Suite 130b FAIRBANKS |
State: | AK |
Postal Code: | 997014054 |
Phone Number: | 9074522178 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2014 |
NPI Last Update Date: | 10/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1187 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |