Healthcare Provider Details

I. General information

NPI: 1386214039
Provider Name (Legal Business Name): NANA MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DIMOND BLVD STE 3-450
ANCHORAGE AK
99515-2059
US

IV. Provider business mailing address

800 E DIMOND BLVD STE 3-450
ANCHORAGE AK
99515-2059
US

V. Phone/Fax

Practice location:
  • Phone: 907-230-9576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEANNETTE DUENOW
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 907-230-9576