Healthcare Provider Details

I. General information

NPI: 1801145925
Provider Name (Legal Business Name): VANNA ELAINE SUMABAT TAVERAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANNA ELAINE FIGUERAS SUMABAT

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W FIREWEED LN STE 160
ANCHORAGE AK
99503
US

IV. Provider business mailing address

510 TYEE CIR
ANCHORAGE AK
99503-7323
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNURR32453
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: