Healthcare Provider Details

I. General information

NPI: 1083887749
Provider Name (Legal Business Name): JEOFFREY WALTER LANFEAR FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44604 STERLING HWY STE D
SOLDOTNA AK
99669-7962
US

IV. Provider business mailing address

4201 TUDOR CENTRE DR SUITE 320
ANCHORAGE AK
99508-5904
US

V. Phone/Fax

Practice location:
  • Phone: 907-420-0585
  • Fax: 907-420-0586
Mailing address:
  • Phone: 907-729-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR U 1026
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: