Healthcare Provider Details

I. General information

NPI: 1922015866
Provider Name (Legal Business Name): KAREN JAYNE O'BLOCK ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN JAYNE MERWIN ANP

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 COWLES ST. SUITE #1
FARIBANKS AK
99701
US

IV. Provider business mailing address

1640 COWLES ST. SUITE #1
FARIBANKS AK
99701
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-4768
  • Fax: 907-452-1009
Mailing address:
  • Phone: 907-452-4768
  • Fax: 907-452-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number244
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: