=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992932503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMEN'S HEALTHCARE CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2009
-----------------------------------------------------
Last Update Date | 06/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4050 LAKE OTIS PKWY SUITE 204 B
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-5223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-929-9586
-----------------------------------------------------
Fax | 907-929-3836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4050 LAKE OTIS PKWY SUITE 204 B
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-5223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-929-9586
-----------------------------------------------------
Fax | 907-929-3836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNDER
-----------------------------------------------------
Name | MS. LEEANNE MERCIER
-----------------------------------------------------
Credential | ANP
-----------------------------------------------------
Telephone | 907-929-9586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 235
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------