Healthcare Provider Details

I. General information

NPI: 1962531301
Provider Name (Legal Business Name): ELIZABETH CHADENE KROME RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 N SAMS DR
WASILLA AK
99654-4311
US

IV. Provider business mailing address

PO BOX 876051
WASILLA AK
99687-6051
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-7767
  • Fax: 907-373-9867
Mailing address:
  • Phone: 907-373-7767
  • Fax: 907-373-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7956
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCM29031
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCMG9061
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: