Basic Information
| Provider Information | |||||||||
| NPI: | 1770555997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORTNER | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD # 7440 | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN: MCUC-MMD-QM | ||||||||
| City: | FT. WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997037440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD # 7440 | ||||||||
| Address2: | BASSETT ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FT. WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997037440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 060951 | MO | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.