Provider Demographics
NPI:1255102513
Name:DIGEORGE, JOAN M (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:DIGEORGE
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 MAVENCAMP CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6574
Mailing Address - Country:US
Mailing Address - Phone:817-513-5787
Mailing Address - Fax:
Practice Address - Street 1:751 OLD RICHARDSON HWY STE 101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7802
Practice Address - Country:US
Practice Address - Phone:907-328-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK163313163W00000X
AK217424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse