MEDICARE: MAUREEN NORTHWAY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1012	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1012	OTHER	AK	ALASKA LICENSE

General Provider Information

NPI Number	:	1295912608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN NORTHWAY FNP-C

Provider Business Mailing Address
First Line	:	5534 NORTH TONGASS HIGHWAY
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5669
Country	:	US
Telephone Number	:	907-225-4325
Fax Number	:	907-531-7369

Provider Business Practice Location Address
First Line	:	5534 NORTH TONGASS HIGHWAY
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5669
Country	:	US
Telephone Number	:	907-225-4325
Fax Number	:	907-531-7369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	08/16/2023

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