Healthcare Provider Details

I. General information

NPI: 1629140629
Provider Name (Legal Business Name): CATHERINE LIDDELOW-THOMPSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 DEBARR RD STE 25
ANCHORAGE AK
99508-2967
US

IV. Provider business mailing address

2841 DEBARR RD STE 25
ANCHORAGE AK
99508-2967
US

V. Phone/Fax

Practice location:
  • Phone: 907-336-3500
  • Fax: 907-264-2336
Mailing address:
  • Phone: 907-336-3500
  • Fax: 907-264-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number411
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: