Healthcare Provider Details

I. General information

NPI: 1053950428
Provider Name (Legal Business Name): WENDY DEGRAFFENRIED RN, HN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W INTERNATIONAL AIRPORT RD STE 17
ANCHORAGE AK
99518-1168
US

IV. Provider business mailing address

401 W INTERNATIONAL AIRPORT RD STE 17
ANCHORAGE AK
99518-1168
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-3656
  • Fax:
Mailing address:
  • Phone: 907-770-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number25807
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number25807
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number25807
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number25807
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number25807
License Number StateAK
# 6
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number25807
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: