Healthcare Provider Details

I. General information

NPI: 1528218302
Provider Name (Legal Business Name): MS. JUDITH MATHILDA LINDENFELSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH MATHILDA O'CONNOR A.N.P.

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16635 CENTERFIELD DR SUITE 200
EAGLE RIVER AK
99577-7719
US

IV. Provider business mailing address

16635 CENTERFIELD DR SUITE 200
EAGLE RIVER AK
99577-7719
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-0493
  • Fax: 907-694-0933
Mailing address:
  • Phone: 907-694-0493
  • Fax: 907-694-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number338
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: