Healthcare Provider Details

I. General information

NPI: 1952835290
Provider Name (Legal Business Name): LORIE J. PETTY APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PIPER ST STE U340
ANCHORAGE AK
99508-6904
US

IV. Provider business mailing address

3851 PIPER ST STE U340
ANCHORAGE AK
99508-6904
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-0321
  • Fax: 907-562-2683
Mailing address:
  • Phone: 907-562-0321
  • Fax: 907-562-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209330
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209330
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209330
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: