Healthcare Provider Details

I. General information

NPI: 1114129608
Provider Name (Legal Business Name): STEPHANIE ELAINE GRIESE WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ELAINE GRIESE M.D.

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E 36TH AVE
ANCHORAGE AK
99503-4166
US

IV. Provider business mailing address

6816 LOWELL CIR
ANCHORAGE AK
99502-1849
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-5090
  • Fax:
Mailing address:
  • Phone: 717-773-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101262085
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD63821
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239083
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036668400
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: