Healthcare Provider Details

I. General information

NPI: 1174743546
Provider Name (Legal Business Name): DANITA SUE PREUSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 PENLAND PKWY STE J11
ANCHORAGE AK
99508-1961
US

IV. Provider business mailing address

4900 N SKYVAN DR
WASILLA AK
99654-9309
US

V. Phone/Fax

Practice location:
  • Phone: 907-334-8527
  • Fax: 907-279-8032
Mailing address:
  • Phone: 907-746-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number23380
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: