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General NPI Number Information
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NPI Number | 1891188074
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Entity Type | Organization
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Legal Business Name | ALASKA WEIGHT MANAGEMENT AND DIABETES COUNSELING
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 642 S ALASKA ST SUITE #101
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City | PALMER
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State | AK
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Zip | 99645-6378
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Country | US
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Telephone | 907-707-1137
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 S KILLARNEY DR
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City | PALMER
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State | AK
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Zip | 99645-8278
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Country | US
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Telephone | 907-841-8978
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | STEPHANIE A FIGON
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Credential | RD
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Telephone | 907-841-8978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DTN D 82
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License Number State | AK
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