Healthcare Provider Details

I. General information

NPI: 1013669704
Provider Name (Legal Business Name): ELIZABETH AHWINONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SAN JERONIMO DR
ANCHORAGE AK
99508-2870
US

IV. Provider business mailing address

3600 SAN JERONIMO DR
ANCHORAGE AK
99508-2870
US

V. Phone/Fax

Practice location:
  • Phone: 907-793-3252
  • Fax:
Mailing address:
  • Phone: 190-757-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number StateAK

VII. Legacy identifiers

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

# 1
Identifier1437273000
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerMEDICAL RECORDS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: