Provider Demographics
NPI:1659673002
Name:RUNSER, AVEE LYNN (PA)
Entity type:Individual
Prefix:
First Name:AVEE
Middle Name:LYNN
Last Name:RUNSER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AVEE
Other - Middle Name:LYNN
Other - Last Name:BURNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1275 SADLER WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3171
Mailing Address - Country:US
Mailing Address - Phone:907-374-6602
Mailing Address - Fax:907-374-6604
Practice Address - Street 1:1275 SADLER WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3171
Practice Address - Country:US
Practice Address - Phone:907-374-6602
Practice Address - Fax:907-374-6604
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant