Individual
MRS. CAROLYN MARGARET BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1001 E BOGARD RD, WASILLA, AK 99654-7114
(907) 376-2225
(907) 376-9225
Mailing address
1001 E BOGARD RD, WASILLA, AK 99654-7114
(907) 376-2225
(907) 376-9225
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
119902014
AK
Other
Enumeration date
08/04/2009
Last updated
07/01/2014
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