Provider Demographics
NPI:1396813762
Name:COX, JAWANA JEAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JAWANA
Middle Name:JEAN
Last Name:COX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 WAGNER LN
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-2827
Mailing Address - Country:US
Mailing Address - Phone:907-488-4977
Mailing Address - Fax:
Practice Address - Street 1:654 WAGNER LN
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-2827
Practice Address - Country:US
Practice Address - Phone:907-488-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK712030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist