Healthcare Provider Details

I. General information

NPI: 1538772173
Provider Name (Legal Business Name): EAGLE HEALTH ALASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MERRILL FIELD DR
ANCHORAGE AK
99501-4137
US

IV. Provider business mailing address

PO BOX 671336
CHUGIAK AK
99567-1336
US

V. Phone/Fax

Practice location:
  • Phone: 907-201-1102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN LYNN NINEFELDT
Title or Position: OWNER
Credential: MD
Phone: 907-201-1102