Individual
CAMERON R MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1074009
NATIONAL CERTIFICATION
—
Enumeration date
01/09/2007
Last updated
07/08/2007
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