Healthcare Provider Details

I. General information

NPI: 1255174132
Provider Name (Legal Business Name): AMELIA WILDER FRISBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S SEWARD MERIDIAN PKWY # ABC
WASILLA AK
99654-8312
US

IV. Provider business mailing address

1550 E 74TH AVE
ANCHORAGE AK
99507-2614
US

V. Phone/Fax

Practice location:
  • Phone: 907-631-3520
  • Fax:
Mailing address:
  • Phone: 907-929-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: