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General NPI Number Information
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NPI Number | 1801174586
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Entity Type | Organization
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Legal Business Name | FAMILY DIABETES CLINIC
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 1407 W 31ST AVE STE. 600
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City | ANCHORAGE
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State | AK
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Zip | 99503-3678
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Country | US
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Telephone | 907-677-3750
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Fax | 907-677-3751
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Provider Business Mailing Address
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Address Line | 1407 W 31ST AVE STE. 200
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City | ANCHORAGE
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State | AK
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Zip | 99503-3678
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Country | US
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Telephone | 907-677-3750
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Fax | 907-677-3751
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Authorized Official
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Title or Position | OWNER
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Name | TRACY L MICHALSKI
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Credential | ANP
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Telephone | 907-677-3750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 688
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License Number State | AK
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