Provider Demographics
NPI:1225105919
Name:GNEITING, ROBERT W (FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:GNEITING
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685-0144
Mailing Address - Country:US
Mailing Address - Phone:907-581-1202
Mailing Address - Fax:907-581-2331
Practice Address - Street 1:34 LAVELLE COURT
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685
Practice Address - Country:US
Practice Address - Phone:907-581-1202
Practice Address - Fax:907-581-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1659A363LF0000X
AK123290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT81-0230409OtherCS&KT FLATHEAD RESERVATION
UT200098472OtherTAX ID
MT81-0463482OtherTIN
UT200098472OtherTAX ID
MT81-0230409OtherCS&KT FLATHEAD RESERVATION