Healthcare Provider Details

I. General information

NPI: 1053965715
Provider Name (Legal Business Name): NOELLINDA CHRISTY PESIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BRAGAW ST
ANCHORAGE AK
99508-3435
US

IV. Provider business mailing address

1650 SOUTH BRAGAW
ANCHORAGE AK
99508-3435
US

V. Phone/Fax

Practice location:
  • Phone: 907-433-7320
  • Fax: 907-274-6413
Mailing address:
  • Phone: 907-433-7320
  • Fax: 907-274-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: