Healthcare Provider Details

I. General information

NPI: 1851919146
Provider Name (Legal Business Name): ALASKA DIGESTIVE AND LIVER DISEASE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PIPER ST STE U466
ANCHORAGE AK
99508-6905
US

IV. Provider business mailing address

3851 PIPER ST STE U466
ANCHORAGE AK
99508-6905
US

V. Phone/Fax

Practice location:
  • Phone: 907-569-1333
  • Fax: 907-569-1433
Mailing address:
  • Phone: 907-569-1333
  • Fax: 907-569-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY TYLOR RYZNAR
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 907-569-1333