Healthcare Provider Details

I. General information

NPI: 1780420893
Provider Name (Legal Business Name): TWYLA ELHARDT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 528
BETHEL AK
99559-0528
US

IV. Provider business mailing address

PO BOX 2001
BETHEL AK
99559-2001
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6603
  • Fax:
Mailing address:
  • Phone: 907-545-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103298
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: