Graduated: 2015
NPI: 1407243835
Practice Locations (2)
TANANA VALLEY CLINIC LLC
1650 COWLES ST
FAIRBANKS, AK 997015907
9074593500
PROVIDENCE HEALTH AND SERVICE- WASHINGTON
101 W 8TH AVE
SPOKANE, WA 992042307
5094743131
Source: CMS National Downloadable File, September 2026.