Healthcare Provider Details

I. General information

NPI: 1164397485
Provider Name (Legal Business Name): LIGHTHOUSE FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E WESTPOINT DRIVE SUITE B1-5
WASILLA AK
99654
US

IV. Provider business mailing address

2015 E STALLION CIRCLE
WASILLA AK
99654
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-5483
  • Fax: 907-357-5484
Mailing address:
  • Phone: 907-290-1095
  • Fax: 907-357-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH CATHERINE TURGEON
Title or Position: OWNER
Credential: MS
Phone: 907-290-1095