Healthcare Provider Details

I. General information

NPI: 1396926713
Provider Name (Legal Business Name): WENDY IMHOFF RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

PO BOX 384652
WAIKOLOA HI
96738-4652
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8331
  • Fax:
Mailing address:
  • Phone: 808-937-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number27906
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: