Provider Demographics
NPI:1134295082
Name:FLORA, MARY J (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:FLORA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:642 21ST AVE
Mailing Address - Street 2:#F
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-457-4292
Mailing Address - Fax:
Practice Address - Street 1:309 SPRUCE STREET
Practice Address - Street 2:YUKON FLATS HEALTH CENTER
Practice Address - City:FORT YUKON
Practice Address - State:AK
Practice Address - Zip Code:99740
Practice Address - Country:US
Practice Address - Phone:907-662-2460
Practice Address - Fax:907-662-2709
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK17927163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator