Healthcare Provider Details

I. General information

NPI: 1780240515
Provider Name (Legal Business Name): CAROL JANE ROOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE ST
ANCHORAGE AK
99501-2626
US

IV. Provider business mailing address

12920 HILLSIDE DR UNIT A
ANCHORAGE AK
99516-3260
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-6579
  • Fax:
Mailing address:
  • Phone: 336-688-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberNURR29539
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: