Healthcare Provider Details

I. General information

NPI: 1053677203
Provider Name (Legal Business Name): NOELLE BETH CAMARENA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503
US

IV. Provider business mailing address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503-7174
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-7200
  • Fax: 907-743-7241
Mailing address:
  • Phone: 907-743-7386
  • Fax: 907-743-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number764393
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: