Healthcare Provider Details

I. General information

NPI: 1235820929
Provider Name (Legal Business Name): TODD WHITCOMB RNCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 TUDOR CENTRE DR # 300
ANCHORAGE AK
99508-5904
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2500
  • Fax:
Mailing address:
  • Phone: 907-729-8901
  • Fax: 907-729-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number122224
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: