Healthcare Provider Details

I. General information

NPI: 1902184203
Provider Name (Legal Business Name): D.L.DOORNBOS FNP-BC, MSN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 STELLER DR
ANCHORAGE AK
99504-4225
US

IV. Provider business mailing address

3970 STELLER DR
ANCHORAGE AK
99504-4225
US

V. Phone/Fax

Practice location:
  • Phone: 907-242-7384
  • Fax:
Mailing address:
  • Phone: 907-242-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number960196
License Number StateAK

VIII. Authorized Official

Name: DEBRA L DOORNBOS
Title or Position: OWNER
Credential: FNP-BC MSN
Phone: 907-242-7384