Healthcare Provider Details

I. General information

NPI: 1144536061
Provider Name (Legal Business Name): AMBRIA MARIE YOUNKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 GEIST RD
FAIRBANKS AK
99709-3548
US

IV. Provider business mailing address

3745 GEIST RD
FAIRBANKS AK
99709-3548
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-3338
  • Fax: 907-456-3443
Mailing address:
  • Phone: 907-456-3338
  • Fax: 907-456-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: