Healthcare Provider Details

I. General information

NPI: 1841407897
Provider Name (Legal Business Name): LEE ANN WACHMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FRONT ST
JUNEAU AK
99801-1251
US

IV. Provider business mailing address

8678 DUDLEY ST
JUNEAU AK
99801-9050
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-4201
  • Fax: 907-046-3661
Mailing address:
  • Phone: 907-789-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number12152
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: