Healthcare Provider Details

I. General information

NPI: 1962952234
Provider Name (Legal Business Name): MEGAN HURLBURT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PROVIDENCE DR SUITE 358
ANCHORAGE AK
99508-4691
US

IV. Provider business mailing address

3340 PROVIDENCE DR SUITE 358
ANCHORAGE AK
99508-4691
US

V. Phone/Fax

Practice location:
  • Phone: 907-843-0532
  • Fax: 907-278-2881
Mailing address:
  • Phone: 907-843-0532
  • Fax: 907-278-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number114996
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: