Individual
MR. NATHAN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22301 W ALSOP RD, WASILLA, AK 99623-5023
(907) 864-8284
Mailing address
22301 W ALSOP RD, WASILLA, AK 99623-5023
(907) 864-8284
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
123843
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1677181
—
AK
Enumeration date
09/06/2017
Last updated
07/28/2020
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