Healthcare Provider Details

I. General information

NPI: 1073933644
Provider Name (Legal Business Name): SAGE AN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DEBARR CIR
ANCHORAGE AK
99508-2984
US

IV. Provider business mailing address

1500 DEBARR CIR
ANCHORAGE AK
99508-2984
US

V. Phone/Fax

Practice location:
  • Phone: 907-258-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number14031
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122040
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: