Provider Demographics
NPI:1073671822
Name:MCBRAYER, GEORGANN (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:GEORGANN
Middle Name:
Last Name:MCBRAYER
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:GEORGANN
Other - Middle Name:MCBRAYER
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CNM
Mailing Address - Street 1:PO BOX 81517
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-1517
Mailing Address - Country:US
Mailing Address - Phone:505-400-9293
Mailing Address - Fax:907-458-7006
Practice Address - Street 1:930 ELLESMERE DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-9970
Practice Address - Country:US
Practice Address - Phone:505-400-9293
Practice Address - Fax:505-400-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1279367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife