=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518143106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH AND WELLNESS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2008
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2751 DEBARR RD BLDG B.STE.#360
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-336-3500
-----------------------------------------------------
Fax | 907-336-3504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2751 DEBARR RD BLDG B.STE.#360
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-336-3500
-----------------------------------------------------
Fax | 907-336-3504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | CATHERINE LIDDELOW-THOMPSON
-----------------------------------------------------
Credential | A.N.P
-----------------------------------------------------
Telephone | 907-336-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 411
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------