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NPI Code Detail

MEDICARE: GREATLAND WOMEN'S HEALTCARE, LLC

MEDICARE: GREATLAND WOMEN'S HEALTCARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WW0101XAmbulatory Women's Health Care Registered Nurse879AK

General Provider Information

NPI Number : 1013378744
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREATLAND WOMEN'S HEALTCARE, LLC
Provider Business Mailing Address
First Line : 5805 E COLUMBUS WAY
Second Line : PO BOX 876201
City : WASILLA
State : AK
Zip : 99654-7831
Country : US
Telephone Number : 907-373-5400
Fax Number : 907-373-5417
Provider Business Practice Location Address
First Line : 5805 E COLUMBUS WAY
Second Line :
City : WASILLA
State : AK
Zip : 99654-7831
Country : US
Telephone Number : 907-373-5400
Fax Number : 907-373-5417
Authorized Official
Title or Position : WOMEN'S HEALTH NURSE PRACTITIONER
Name : MICHAEL VON AH
Credential : ANP
Telephone Number : 907-373-5400
Provider Enumeration Date : 03/08/2016
Last Update Date : 03/08/2016

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Directions to “GREATLAND WOMEN'S HEALTCARE, LLC ” Practice Location

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