Healthcare Provider Details

I. General information

NPI: 1295374510
Provider Name (Legal Business Name): ALASKA PROFESSIONAL NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10672 KENAI SPUR HIGHWAY SUITE 112 -132
KENAI AK
99611-9961
US

IV. Provider business mailing address

LB 357724 PO BOX 3577
SEATTLE WA
98124-3577
US

V. Phone/Fax

Practice location:
  • Phone: 713-253-7432
  • Fax: 225-612-6561
Mailing address:
  • Phone: 936-205-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: KATHY REED
Title or Position: MANAGER
Credential:
Phone: 713-253-7432