Healthcare Provider Details

I. General information

NPI: 1255871034
Provider Name (Legal Business Name): CASEY PLOOF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SALMON CREEK LN
JUNEAU AK
99801-7864
US

IV. Provider business mailing address

1801 SALMON CREEK LN
JUNEAU AK
99801-7864
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-2434
  • Fax:
Mailing address:
  • Phone: 907-586-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number119901
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: