Healthcare Provider Details

I. General information

NPI: 1134640592
Provider Name (Legal Business Name): AURORA WOMENS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 E COUNTRY FIELD CIR STE E
WASILLA AK
99654-6659
US

IV. Provider business mailing address

3750 E COUNTRY FIELD CIR STE E
WASILLA AK
99654-6659
US

V. Phone/Fax

Practice location:
  • Phone: 907-841-0964
  • Fax: 205-972-8166
Mailing address:
  • Phone: 907-376-7747
  • Fax: 907-376-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMEDS4644
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MICHAEL GLEN FITZGERALD
Title or Position: PHYSICIAN
Credential: MD
Phone: 907-376-7747