Healthcare Provider Details

I. General information

NPI: 1124491501
Provider Name (Legal Business Name): SARA ATHEA STETSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SARA ATHEA CHISM

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 OLD SEWARD HWY STE 107
ANCHORAGE AK
99515-3098
US

IV. Provider business mailing address

9500 INDEPENDENCE DR STE 100
ANCHORAGE AK
99507-4686
US

V. Phone/Fax

Practice location:
  • Phone: 907-433-5100
  • Fax:
Mailing address:
  • Phone: 907-339-7272
  • Fax: 907-339-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1514
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: