Healthcare Provider Details

I. General information

NPI: 1023492642
Provider Name (Legal Business Name): JENNIFER RIBAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NOBLE ST
FAIRBANKS AK
99701-4948
US

IV. Provider business mailing address

1379 COMPTON CT
EAST LANSING MI
48823-2386
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3500
  • Fax:
Mailing address:
  • Phone: 907-378-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5315071478
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number131171
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: