Healthcare Provider Details

I. General information

NPI: 1033148028
Provider Name (Legal Business Name): BARBARA A. MARYAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 DENALI ST STE 203
ANCHORAGE AK
99503-4039
US

IV. Provider business mailing address

301 W. NORTHERN LIGHTS BLVD SUITE #638
ANCHORAGE AK
99503
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-3345
  • Fax: 907-562-9681
Mailing address:
  • Phone: 907-562-3345
  • Fax: 907-562-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberANPLIC#170
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number170
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFTLIC#33
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: