Individual
MS. KENDEL LYNN BORMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1606 23RD AVE, FAIRBANKS, AK 99701-6407
(907) 455-4567
(907) 458-1580
Mailing address
1606 23RD AVE, FAIRBANKS, AK 99701-6407
(907) 455-4567
(907) 458-1580
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2096
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2096
OCCUPATIONAL LICENSE
AK
Enumeration date
11/19/2010
Last updated
11/19/2010
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