Healthcare Provider Details

I. General information

NPI: 1265616783
Provider Name (Legal Business Name): KAREN PUDGE DBA FORGET-ME-NOT CARE COORDINATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E 145TH AVENUE
ANCHORAGE AK
99516
US

IV. Provider business mailing address

PO BOX 110297 FOREGET-ME-NOT CARE COORDINATION
ANCHORAGE AK
99511-0297
US

V. Phone/Fax

Practice location:
  • Phone: 907-646-9877
  • Fax: 907-646-1991
Mailing address:
  • Phone: 907-646-9877
  • Fax: 907-646-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number746363
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number746363
License Number StateAK

VIII. Authorized Official

Name: MRS. KAREN LOUISE PUDGE
Title or Position: SOLE EMPLOYEE PROPRIETOR
Credential: BSW
Phone: 907-646-9877