Healthcare Provider Details

I. General information

NPI: 1518068485
Provider Name (Legal Business Name): LYNN ELLEN HARTZ ANP FNP MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 LAKE OTIS PARKWAY
ANCHORAGE AK
99508-5214
US

IV. Provider business mailing address

3104 BROOKSIDE DRIVE
ANCHORAGE AK
99517-1882
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2965
  • Fax: 907-561-1257
Mailing address:
  • Phone: 907-248-4877
  • Fax: 907-561-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6966
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0006
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number6966
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0006
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: