Healthcare Provider Details

I. General information

NPI: 1235235185
Provider Name (Legal Business Name): AMANDA JEAN ARRA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SALMON CREEK LANE
JUNEAU AK
99801
US

IV. Provider business mailing address

1601 SALMON CREEK LANE
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-1203
  • Fax: 907-586-5765
Mailing address:
  • Phone: 907-586-1203
  • Fax: 907-586-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number549
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: