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General NPI Number Information
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NPI Number | 1063811255
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Entity Type | Organization
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Legal Business Name | ARCTIC PAIN MANAGEMENT INC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 330 OLD STEESE HWY
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City | FAIRBANKS
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State | AK
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Zip | 99701-3126
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Country | US
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Telephone | 206-459-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 308 OLD STEESE HWY
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City | FAIRBANKS
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State | AK
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Zip | 99701-3126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT LEWIS
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Credential | DC
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Telephone | 206-459-4108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NURU1305
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License Number State | AK
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