Healthcare Provider Details

I. General information

NPI: 1013037068
Provider Name (Legal Business Name): LOIS A ROCKCASTLE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 UNIVERSITY LAKE DR STE 205
ANCHORAGE AK
99508-4658
US

IV. Provider business mailing address

9330 BASHER DR
ANCHORAGE AK
99507-1278
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1600
  • Fax: 907-563-0100
Mailing address:
  • Phone: 907-337-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number273
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330059-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: