Provider Demographics
NPI:1598862476
Name:NETTLOW, MARY MCKENZIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MCKENZIE
Last Name:NETTLOW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4300 B ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5925
Mailing Address - Country:US
Mailing Address - Phone:907-375-3355
Mailing Address - Fax:907-375-3351
Practice Address - Street 1:4300 B ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5925
Practice Address - Country:US
Practice Address - Phone:907-375-3355
Practice Address - Fax:907-375-3351
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK6706208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD6018Medicaid