Healthcare Provider Details

I. General information

NPI: 1114091527
Provider Name (Legal Business Name): HELYN M LEFGREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SANTA CLAUS LANE
NORTH POLE AK
99705
US

IV. Provider business mailing address

PO BOX 60743
FAIRBANKS AK
99705
US

V. Phone/Fax

Practice location:
  • Phone: 907-488-4433
  • Fax:
Mailing address:
  • Phone: 907-488-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1471
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: