Healthcare Provider Details

I. General information

NPI: 1174071641
Provider Name (Legal Business Name): CASTA TOWNSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17101 SNOWMOBILE LN STE 102
EAGLE RIVER AK
99577-7043
US

IV. Provider business mailing address

17101 SNOWMOBILE LN STE 102
EAGLE RIVER AK
99577-7043
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-7223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113707
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: