Healthcare Provider Details

I. General information

NPI: 1891741526
Provider Name (Legal Business Name): KERRY DORIUS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LINDBLAD AVE.
GIRDWOOD AK
99587-5623
US

IV. Provider business mailing address

PO BOX 1130
GIRDWOOD AK
99587-1130
US

V. Phone/Fax

Practice location:
  • Phone: 907-783-1355
  • Fax: 907-783-1357
Mailing address:
  • Phone: 907-783-1355
  • Fax: 907-783-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number362
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: