Healthcare Provider Details

I. General information

NPI: 1912357286
Provider Name (Legal Business Name): DENALI ASTHMA & PULMONARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W PARKS HWY SUITE 100A
WASILLA AK
99654-6920
US

IV. Provider business mailing address

351 W PARKS HWY SUITE 100A
WASILLA AK
99654-6920
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-8483
  • Fax:
Mailing address:
  • Phone: 907-357-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOYCE M SHOTWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 214-824-4412