Individual
MR. THEODORE YNGVE KORSGREN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1717 W. COWLES ST., FAIRBANKS, AK 99701-5903
(907) 451-6682
Mailing address
1717 W. COWLES ST., FAIRBANKS, AK 99701-5903
(907) 451-6682
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5364
AK
Other
Enumeration date
10/02/2007
Last updated
12/03/2012
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