Healthcare Provider Details

I. General information

NPI: 1407380959
Provider Name (Legal Business Name): JOSHUA RYAN FIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 KIMBERLIE CT
ANCHORAGE AK
99508
US

IV. Provider business mailing address

2836 KIMBERLIE CT
ANCHORAGE AK
99508-5329
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-4222
  • Fax:
Mailing address:
  • Phone: 907-349-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-42546
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: