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Organization

FAIRWEATHER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. AMY RENEE BOLAM (PRACTICE MANAGER)
(907) 248-8008
Entity
Organization

Contact information

Practice address
9525 KING ST, ANCHORAGE, AK 99515-1817
(907) 346-3247
(907) 349-1920
Mailing address
7999 JEWEL LAKE RD, ANCHORAGE, AK 99502-4251
(907) 331-3620
(907) 644-4477

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
940479
AK

Other

Enumeration date
02/04/2013
Last updated
12/20/2013
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