=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700569092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE NORTH HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2023
-----------------------------------------------------
Last Update Date | 08/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51849 KENAI SPUR HWY UNIT B
-----------------------------------------------------
City | KENAI
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99611-9269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-776-3661
-----------------------------------------------------
Fax | 907-776-3662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51849 KENAI SPUR HWY UNIT B
-----------------------------------------------------
City | KENAI
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99611-9269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-776-3661
-----------------------------------------------------
Fax | 907-776-3662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, NURSE PRACTITIONER
-----------------------------------------------------
Name | DR. JEANNE PARRISH
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 907-776-3661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------