Healthcare Provider Details

I. General information

NPI: 1407684830
Provider Name (Legal Business Name): MATTISEN ROSE SEPT ZIEGLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MATTISEN ROSE SEPT

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 HUFFMAN PARK DR STE 110
ANCHORAGE AK
99515-3519
US

IV. Provider business mailing address

PO BOX 2928
PORTLAND OR
97208-2928
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax: 503-893-6847
Mailing address:
  • Phone: 425-207-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227114
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number227114
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number227114
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: