Healthcare Provider Details

I. General information

NPI: 1689612269
Provider Name (Legal Business Name): LORI JEAN ZITZMANN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W NORTHERN LIGHTS BLVD
ANCHORAGE AK
99503-2408
US

IV. Provider business mailing address

1544 W 14TH AVE
ANCHORAGE AK
99501-4930
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-6700
  • Fax: 907-770-6707
Mailing address:
  • Phone: 907-770-6700
  • Fax: 907-770-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number646
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: