Healthcare Provider Details

I. General information

NPI: 1326757949
Provider Name (Legal Business Name): SOLDOTNA FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44604 STERLING HWY STE D
SOLDOTNA AK
99669-7962
US

IV. Provider business mailing address

44604 STERLING HWY STE D
SOLDOTNA AK
99669-7962
US

V. Phone/Fax

Practice location:
  • Phone: 907-420-0585
  • Fax:
Mailing address:
  • Phone: 907-420-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA M LANFEAR
Title or Position: MEMBER
Credential:
Phone: 907-420-0585