Healthcare Provider Details

I. General information

NPI: 1326162454
Provider Name (Legal Business Name): WELLSPRING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 JORDAN AVE
JUNEAU AK
99801-8050
US

IV. Provider business mailing address

2231 JORDAN AVE
JUNEAU AK
99801-8050
US

V. Phone/Fax

Practice location:
  • Phone: 907-789-1812
  • Fax: 907-789-7168
Mailing address:
  • Phone: 907-789-1812
  • Fax: 907-789-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. COLLEEN C JAEGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 907-789-1812