Healthcare Provider Details

I. General information

NPI: 1245642818
Provider Name (Legal Business Name): ANNA ENZWEILER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 N ROBIN CIR # 2
WASILLA AK
99654-6800
US

IV. Provider business mailing address

561 N ROBIN CIR # 2
WASILLA AK
99654-6800
US

V. Phone/Fax

Practice location:
  • Phone: 907-775-5388
  • Fax:
Mailing address:
  • Phone: 907-775-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number33875
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: