Healthcare Provider Details

I. General information

NPI: 1043738537
Provider Name (Legal Business Name): NATALIE ELAINE PETER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CENTRAL AVE
EIELSON AFB AK
99702-2301
US

IV. Provider business mailing address

2630 CENTRAL AVE
EIELSON AFB AK
99702-2301
US

V. Phone/Fax

Practice location:
  • Phone: 907-377-3071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085364
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: