Healthcare Provider Details

I. General information

NPI: 1124249164
Provider Name (Legal Business Name): ANNE WILLARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE CRAIG

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TOKSOOK BAY SUB-REGIONAL CLINIC
TOKSOOK BAY AK
99637
US

IV. Provider business mailing address

P.O. BOX 37028
TOKSOOK BAY AK
99637
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number23973
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number816
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: