Healthcare Provider Details

I. General information

NPI: 1447857875
Provider Name (Legal Business Name): ALLISON PHILLIPS MOE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR STE 2300
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

904 CLAY CT
ANCHORAGE AK
99503
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3300
  • Fax:
Mailing address:
  • Phone: 541-390-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number161679
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: