Healthcare Provider Details

I. General information

NPI: 1679772735
Provider Name (Legal Business Name): HEALTH WORKS FAMILY MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 OLD GLENN HWY STE A7
EAGLE RIVER AK
99577-7003
US

IV. Provider business mailing address

12812 OLD GLENN HWY SUITE A7
EAGLE RIVER AK
99577-7558
US

V. Phone/Fax

Practice location:
  • Phone: 907-622-9675
  • Fax:
Mailing address:
  • Phone: 907-770-2301
  • Fax: 907-770-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN EGBERT
Title or Position: OWNER
Credential: A.N.P.
Phone: 907-622-9675