Healthcare Provider Details

I. General information

NPI: 1912483397
Provider Name (Legal Business Name): AMBER DAWN DEERE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E RAILROAD AVE STE 210
WASILLA AK
99654-8137
US

IV. Provider business mailing address

PO BOX 870606
WASILLA AK
99687-0606
US

V. Phone/Fax

Practice location:
  • Phone: 907-313-7965
  • Fax: 907-531-3886
Mailing address:
  • Phone: 907-313-7965
  • Fax: 907-531-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5989
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR36801
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number249489
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: