Basic Information
| Provider Information | |||||||||
| NPI: | 1740433689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | PRIOR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 PROVIDENCE DR | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075610005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 PROVIDENCE DR | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075610005 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | R70637 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 207L00000X | 7966 | AK | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.