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General NPI Number Information
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NPI Number | 1083640387
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS VON AH WHNP
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Gender | Male
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 9761 W MARGIN WAY
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City | WASILLA
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State | AK
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Zip | 99623
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Country | US
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Telephone | 907-373-5400
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Fax | 907-373-5740
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Provider Business Mailing Address
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Address Line | 1125 N COLONIAL DR
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City | WASILLA
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State | AK
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Zip | 99654-6760
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 879
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License Number State | AK
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