Provider Demographics
NPI:1447668082
Name:FURROW, BETH I (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:FURROW
Suffix:I
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 MARY ANN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6131
Mailing Address - Country:US
Mailing Address - Phone:907-799-9017
Mailing Address - Fax:
Practice Address - Street 1:1300 MOORE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5761
Practice Address - Country:US
Practice Address - Phone:907-371-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X, 247200000X
AK7053374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374U00000XNursing Service Related ProvidersHome Health Aide