Healthcare Provider Details

I. General information

NPI: 1518361898
Provider Name (Legal Business Name): MARY ALLISON MCQUILKIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

PO BOX 35198
SEATTLE WA
98124-5198
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3300
  • Fax: 907-729-8607
Mailing address:
  • Phone: 907-729-6977
  • Fax: 907-729-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95001578
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number178871
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number756547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: