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NPI Code Detail

MEDICARE: LOUISE DIANE SHAVINGS MSW

MEDICARE: LOUISE DIANE SHAVINGS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NAOTHERNA

General Provider Information

NPI Number : 1063073419
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUISE DIANE SHAVINGS MSW
Provider Business Mailing Address
First Line : 2825 W 42ND AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99517-2830
Country : US
Telephone Number : 907-243-5130
Fax Number : 907-248-8350
Provider Business Practice Location Address
First Line : 2825 W 42ND AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99517-2830
Country : US
Telephone Number : 907-243-5130
Fax Number : 907-248-8350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2019
Last Update Date : 06/26/2019

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