MEDICARE: MICHAEL THOMAS VON AH WHNP

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
1	363LW0102X	Women's Health Nurse Practitioner	879	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083640387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL THOMAS VON AH WHNP

Provider Business Mailing Address
First Line	:	1125 N COLONIAL DR
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-6760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9761 W MARGIN WAY
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623
Country	:	US
Telephone Number	:	907-373-5400
Fax Number	:	907-373-5740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/17/2018

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