Individual
JODI ANN IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 SLATER DR, FAIRBANKS, AK 99701-3427
(907) 451-0389
(907) 451-0210
Mailing address
805 AIRPORT WAY, FAIRBANKS, AK 99701-6039
(907) 451-0389
(907) 451-0210
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2528
—
AK
Enumeration date
05/15/2007
Last updated
07/09/2007
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