Healthcare Provider Details

I. General information

NPI: 1326525155
Provider Name (Legal Business Name): ISABEL VESELY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 DEBARR RD STE C
ANCHORAGE AK
99504-1783
US

IV. Provider business mailing address

6307 DEBARR RD STE C
ANCHORAGE AK
99504-1783
US

V. Phone/Fax

Practice location:
  • Phone: 907-333-7425
  • Fax:
Mailing address:
  • Phone: 907-333-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number135206
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: