Healthcare Provider Details

I. General information

NPI: 1043171663
Provider Name (Legal Business Name): CHRISTOPHER ORION PETRUSKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26731 W POINT MACKENZIE RD
WASILLA AK
99623-8709
US

IV. Provider business mailing address

26731 W POINT MACKENZIE RD
WASILLA AK
99623-8709
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-4534
  • Fax: 907-376-2348
Mailing address:
  • Phone: 907-376-4534
  • Fax: 907-376-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: