Healthcare Provider Details

I. General information

NPI: 1043213507
Provider Name (Legal Business Name): JANICE L STABLES MSN, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 AIRPORT WAY STE 110B
FAIRBANKS AK
99701-4054
US

IV. Provider business mailing address

1867 AIRPORT WAY STE 110B
FAIRBANKS AK
99701-4054
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-6330
  • Fax: 907-452-6335
Mailing address:
  • Phone: 907-452-6330
  • Fax: 907-452-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number420
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number420
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: