Healthcare Provider Details

I. General information

NPI: 1205176245
Provider Name (Legal Business Name): RAVENWOOD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 LAKE OTIS PKWY 202
ANCHORAGE AK
99508-5226
US

IV. Provider business mailing address

4200 LAKE OTIS PKWY 202
ANCHORAGE AK
99508-5226
US

V. Phone/Fax

Practice location:
  • Phone: 907-338-2273
  • Fax: 907-338-2284
Mailing address:
  • Phone: 907-338-2273
  • Fax: 907-338-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1111
License Number StateAK

VIII. Authorized Official

Name: CHRISTY SLATER
Title or Position: MANAGING MEMBER
Credential:
Phone: 907-338-2273