Healthcare Provider Details

I. General information

NPI: 1437994795
Provider Name (Legal Business Name): NASHCHAREEN MEDOR PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NASHCHAREEN MEDOR JESSEN

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date: 06/08/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

3760 PIPER ST
ANCHORAGE AK
99508-4683
US

IV. Provider business mailing address

3760 PIPER ST
ANCHORAGE AK
99508-4683
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-5006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95376233
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number253947
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: