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General NPI Number Information
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NPI Number | 1205035573
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Entity Type | Organization
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Legal Business Name | WHITE SKYE SUMMIT LLC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 2851 E PALMER WASILLA HWY STE 3
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City | WASILLA
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State | AK
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Zip | 99654-7499
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Country | US
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Telephone | 907-357-7944
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Fax | 907-357-7991
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Provider Business Mailing Address
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Address Line | 561 S DENALI SUITE E
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City | PALMER
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State | AK
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Zip | 99645
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Country | US
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Telephone | 907-745-7944
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Fax | 907-745-7918
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | REBECCA SC WHITE
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Credential | MD
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Telephone | 907-357-7944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2726
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License Number State | AK
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