Healthcare Provider Details

I. General information

NPI: 1104979806
Provider Name (Legal Business Name): MUNICIPALITY OF ANCHORAGE PAYROLL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 L ST
ANCHORAGE AK
99501-3337
US

IV. Provider business mailing address

PO BOX 196650
ANCHORAGE AK
99519-6650
US

V. Phone/Fax

Practice location:
  • Phone: 907-343-6872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2307
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number2307
License Number StateAK

VIII. Authorized Official

Name: MRS. DIANE INGLE
Title or Position: DIRECTOR OF DHHS
Credential:
Phone: 907-343-6460