Individual
LIISIA RAE EDWARDSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHAIII
Contact information
Practice address
122 1ST AVE STE 106, FAIRBANKS, AK 99701-4871
(907) 452-8251
Mailing address
122 1ST AVE STE 106, FAIRBANKS, AK 99701-4871
(907) 452-8251
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
UNKNOWN
—
AK
Enumeration date
06/30/2022
Last updated
06/30/2022
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