Healthcare Provider Details

I. General information

NPI: 1013101203
Provider Name (Legal Business Name): JULIE WILLARD-SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 LATOUCHE ST
ANCHORAGE AK
99508-4209
US

IV. Provider business mailing address

3546 LATOUCHE ST
ANCHORAGE AK
99508-4209
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-0130
  • Fax: 907-563-0135
Mailing address:
  • Phone: 907-563-0130
  • Fax: 907-563-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR22388
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: