Healthcare Provider Details

I. General information

NPI: 1285649731
Provider Name (Legal Business Name): NANCY J OUIMET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 BUSINESS BLVD SUITE 6 PMB 376
EAGLE RIVER AK
99577-7741
US

IV. Provider business mailing address

12110 BUSINESS BLVD SUITE 6 PMB 376
EAGLE RIVER AK
99577-7741
US

V. Phone/Fax

Practice location:
  • Phone: 907-301-9416
  • Fax:
Mailing address:
  • Phone: 907-301-9416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2036
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierMD20361
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: