Healthcare Provider Details

I. General information

NPI: 1427060078
Provider Name (Legal Business Name): JULIE LYNN WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 DEBARR RD STE 307
ANCHORAGE AK
99508-2972
US

IV. Provider business mailing address

2741 DEBARR RD STE 307
ANCHORAGE AK
99508-2972
US

V. Phone/Fax

Practice location:
  • Phone: 907-777-1850
  • Fax: 855-468-1357
Mailing address:
  • Phone: 907-777-1850
  • Fax: 855-468-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4385
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: