Healthcare Provider Details

I. General information

NPI: 1306513445
Provider Name (Legal Business Name): HILARY WALTERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W DIMOND BLVD
ANCHORAGE AK
99515-1704
US

IV. Provider business mailing address

621 W DIMOND BLVD
ANCHORAGE AK
99515-1704
US

V. Phone/Fax

Practice location:
  • Phone: 907-644-8733
  • Fax:
Mailing address:
  • Phone: 907-644-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number177660
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: