Healthcare Provider Details

I. General information

NPI: 1235837865
Provider Name (Legal Business Name): MELISSA VAN FOSSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W TUDOR RD STE 1
ANCHORAGE AK
99503-6649
US

IV. Provider business mailing address

10715 BRIGGS CACHE CIR
EAGLE RIVER AK
99577-8194
US

V. Phone/Fax

Practice location:
  • Phone: 907-744-1944
  • Fax: 907-921-7669
Mailing address:
  • Phone: 406-531-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203486
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: