| NPI | 1992139737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK POLITO Billing Manager 907-562-4142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 1356) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AK 1333) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2013-08-28 |