Healthcare Provider Details

I. General information

NPI: 1841504883
Provider Name (Legal Business Name): STEPHANIE ANN FIGON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE ANN ULRICH

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 SOUTH KILLARNEY DRIVE
PALMER AK
99645
US

IV. Provider business mailing address

2030 SOUTH KILLARNEY DRIVE
PALMER AK
99645
US

V. Phone/Fax

Practice location:
  • Phone: 907-861-6687
  • Fax: 907-861-6567
Mailing address:
  • Phone: 907-841-8978
  • Fax: 907-746-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDTND82
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDTN 82
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDTN 82
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDTN 82
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDTN 82
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDTN 82
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: