Healthcare Provider Details

I. General information

NPI: 1053505206
Provider Name (Legal Business Name): HENRIETTA EMOKIDI DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 140665
ANCHORAGE AK
99514-0665
US

IV. Provider business mailing address

PO BOX 140665
ANCHORAGE AK
99514-0665
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-1703
  • Fax: 907-278-4358
Mailing address:
  • Phone: 907-317-1703
  • Fax: 907-278-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number128333
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number128333
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number128333
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number436940
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: