Healthcare Provider Details

I. General information

NPI: 1508854712
Provider Name (Legal Business Name): DENALI ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 PEGER RD
FAIRBANKS AK
99709-5305
US

IV. Provider business mailing address

14700 28TH AVE N STE 25
PLYMOUTH MN
55447-4884
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-7263
  • Fax:
Mailing address:
  • Phone: 763-553-9920
  • Fax: 763-553-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN MORRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 304-276-3170