Doctor Name: | MAUREEN NORTHWAY |
NPI Number: | 1295912608 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 1012 |
Business Practice Address: | 130 Carlanna Lake Rd Suite 201 Ketchikan, AK - 999015669 |
Business Phone Number: | 9072254325 |
Business Fax Number: | 9072254326 |
Mailing Address: | 130 Carlanna Lake Rd, Suite 201 KETCHIKAN |
State: | AK |
Postal Code: | 999015669 |
Phone Number: | 9072254325 |
Fax Number: | 9072254326 |
NPI Enumeration Date: | 01/28/2008 |
NPI Last Update Date: | 10/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |