Basic Information
| Provider Information | |||||||||
| NPI: | 1043779267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNEY | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CARMEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776 | ||||||||
| Address2: | |||||||||
| City: | WILLOW | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996880776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853515981 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 670 W FIREWEED LN STE 160 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995032561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077700862 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2019 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 103277 | AK | Y | Nursing Service Providers | Registered Nurse |
No ID Information.