Healthcare Provider Details

I. General information

NPI: 1174784391
Provider Name (Legal Business Name): KIMBERLY LYNN GEBAUER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 19TH AVE 4TH FLOOR, CLINICAL NURSING
FAIRBANKS AK
99701-5903
US

IV. Provider business mailing address

1408 19TH AVE 4TH FLOOR, CLINICAL NURSING
FAIRBANKS AK
99701-5903
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-6682
  • Fax: 907-459-3811
Mailing address:
  • Phone: 907-451-6682
  • Fax: 907-459-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number18221
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: