Healthcare Provider Details

I. General information

NPI: 1740561802
Provider Name (Legal Business Name): CLAIRE D'GAIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST STE 101
ANCHORAGE AK
99508-5444
US

IV. Provider business mailing address

4001 DALE ST STE 101
ANCHORAGE AK
99508-5444
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 NumberR14343
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: