=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275993685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENALI ASTHMA AND PULMONARY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2016
-----------------------------------------------------
Last Update Date | 03/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3202 INTERNATIONAL ST SUITE 201
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701-7392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-328-0583
-----------------------------------------------------
Fax | 907-325-0586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3202 INTERNATIONAL ST SUITE 201
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701-7392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-328-0583
-----------------------------------------------------
Fax | 907-325-0586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. JOYCE MERLE SHOTWELL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 907-325-0583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 7517
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------