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General NPI Number Information
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NPI Number | 1780782243
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Entity Type | Individual
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Provider Name | ULYANA PETROVNA STIASSNY MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 1200 AIRPORT HEIGHTS DRIVE SUITE 101
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City | ANCHORAGE
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State | AK
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Zip | 99508
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Country | US
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Telephone | 907-276-2803
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Fax | 907-278-8052
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Provider Business Mailing Address
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Address Line | 188 W NORTHERN LIGHTS BLVD STE 800
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City | ANCHORAGE
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State | AK
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Zip | 99503-3984
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Country | US
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Telephone | 907-276-2803
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Fax | 907-278-8052
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3451
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License Number State | AK
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