Provider Demographics
NPI:1255594586
Name:FROMMER, IDA COLLEEN (RN)
Entity type:Individual
Prefix:MRS
First Name:IDA
Middle Name:COLLEEN
Last Name:FROMMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E DOWLING RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1918
Mailing Address - Country:US
Mailing Address - Phone:907-868-3100
Mailing Address - Fax:907-868-4658
Practice Address - Street 1:1801 E DOWLING RD
Practice Address - Street 2:STE 300
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1918
Practice Address - Country:US
Practice Address - Phone:907-868-3100
Practice Address - Fax:907-868-4658
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK730533171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator