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General NPI Number Information
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NPI Number | 1407264328
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Entity Type | Organization
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Legal Business Name | FORGET ME NOT ULTRASOUND
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 2054 #30TH AVENUE
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City | FAIRBANKS
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State | AK
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Zip | 99701-5720
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Country | US
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Telephone | 907-987-7523
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Fax |
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Provider Business Mailing Address
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Address Line | 3346 DUNDEE LOOP
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City | NORTH POLE
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State | AK
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Zip | 99705-7481
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Country | US
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Telephone | 907-488-1995
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROXANNE ERTEL
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Credential | BA,CNMT,RDMS
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Telephone | 716-984-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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