Healthcare Provider Details

I. General information

NPI: 1306882311
Provider Name (Legal Business Name): PATRICIA MEFFLEY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICE MEFFLEY ANP

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 HUSKY WAY
FAIRBANKS AK
99709-6736
US

IV. Provider business mailing address

1524 HUSKY WAY
FAIRBANKS AK
99709-6736
US

V. Phone/Fax

Practice location:
  • Phone: 907-374-7037
  • Fax: 907-374-7035
Mailing address:
  • Phone: 907-374-7037
  • Fax: 907-374-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number715
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: