Healthcare Provider Details

I. General information

NPI: 1235668443
Provider Name (Legal Business Name): AIMEE M HULL-MALNOSKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22211 BROWNIE DR
EAGLE RIVER AK
99577-9520
US

IV. Provider business mailing address

22211 BROWNIE DR
EAGLE RIVER AK
99577-9520
US

V. Phone/Fax

Practice location:
  • Phone: 907-538-9809
  • Fax:
Mailing address:
  • Phone: 907-538-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1055177
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: