Healthcare Provider Details

I. General information

NPI: 1992951537
Provider Name (Legal Business Name): KOREEN RENEE MATEAKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 B ST STE 100
ANCHORAGE AK
99503-5927
US

IV. Provider business mailing address

4341 B ST STE 100
ANCHORAGE AK
99503-5927
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number25263
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: