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General NPI Number Information
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NPI Number | 1942663190
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Entity Type | Individual
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Provider Name | JENNIFER SUSAN BRACAMONTES MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 09/10/2025
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Provider Practice Location 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 | 99701-5926
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Country | US
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Telephone | 907-729-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 7033 E TUDOR RD
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City | ANCHORAGE
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State | AK
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Zip | 99507-1262
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Country | US
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Telephone | 907-729-3300
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Fax | 907-729-5180
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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 | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 219654
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD61271571
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License Number State | WA
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