Individual
LISA MEMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1096 COPPER ST, NORTH POLE, AK 99705-5775
(907) 460-0143
Mailing address
PO BOX 58659, FAIRBANKS, AK 99711-0659
(907) 460-0143
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
22778
AK
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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