Healthcare Provider Details

I. General information

NPI: 1013353408
Provider Name (Legal Business Name): MARIE MULDOON TAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARIE MULDOON STUEMKE

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 PIPER ST
ANCHORAGE AK
99508-4692
US

IV. Provider business mailing address

3650 PIPER ST
ANCHORAGE AK
99508-4692
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-4624
  • Fax:
Mailing address:
  • Phone: 907-222-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1113
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1113
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: