Healthcare Provider Details

I. General information

NPI: 1265545651
Provider Name (Legal Business Name): AMY A WILLIAMSON ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 AIRPORT WAY STE 4
FAIRBANKS AK
99709-4772
US

IV. Provider business mailing address

3550 AIRPORT WAY STE 4
FAIRBANKS AK
99709-4772
US

V. Phone/Fax

Practice location:
  • Phone: 907-479-2331
  • Fax: 907-479-0164
Mailing address:
  • Phone: 907-479-2331
  • Fax: 907-479-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number40
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNURR16842
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: