Basic Information
Provider Information | |||||||||
NPI: | 1437448933 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TEETS | ||||||||
FirstName: | DOROTHY | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WHEELER | ||||||||
OtherFirstName: | DOROTHY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4352 9TH ST APT 2 | ||||||||
Address2: |   | ||||||||
City: | FORT WAINWRIGHT | ||||||||
State: | AK | ||||||||
PostalCode: | 997031342 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9073701661 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3830 S CUSHMAN ST | ||||||||
Address2: |   | ||||||||
City: | FAIRBANKS | ||||||||
State: | AK | ||||||||
PostalCode: | 997017530 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9074551416 | ||||||||
FaxNumber: | 9074551460 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2011 | ||||||||
LastUpdateDate: | 04/05/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 6756 | AK | Y |   | Nursing Service Providers | Licensed Practical Nurse |   |
No ID Information.