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General NPI Number Information
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NPI Number | 1679563829
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Entity Type | Individual
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Provider Name | MARILYN ELAINE ATTLA PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 1717 W COWLES ST C.A.I.H.C.
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City | FAIRBANKS
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State | AK
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Zip | 99701-5926
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Country | US
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Telephone | 907-451-6682
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Fax | 907-459-3817
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Provider Business Mailing Address
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Address Line | 1717 W. COWLES ST.
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-451-6682
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Fax | 907-574-3922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 320
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License Number State | AK
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