Individual
LISA MARIE MCENULTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAS
Contact information
Practice address
1027 EVERGREEN ST, FAIRBANKS, AK 99709-4306
(907) 451-8164
(907) 451-0273
Mailing address
1041 KELLUM ST APT D305, FAIRBANKS, AK 99701-4396
(907) 687-7966
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/16/2019
Last updated
08/16/2019
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