Provider Demographics
NPI:1285667501
Name:FEAREY, DONNA A (ANP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:FEAREY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 C ST STE 540
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5932
Mailing Address - Country:US
Mailing Address - Phone:907-269-8000
Mailing Address - Fax:907-562-7802
Practice Address - Street 1:3601 C ST STE 540
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5932
Practice Address - Country:US
Practice Address - Phone:907-269-8000
Practice Address - Fax:907-562-7802
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP05341Medicaid
AKP56061Medicare UPIN
AK8EZ16FMedicare ID - Type Unspecified