Individual
JENNIFER DYKSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
8801 W. ANGEL DR, WASILLA, AK 99654
(907) 602-1036
Mailing address
8801 W. ANGEL DR., WASILLA, AK 99654
(907) 602-1036
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
32010
AK
163W00000X
Registered Nurse
RN212367
GA
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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