MEDICARE: MICHELLE LEIOLANI VANDERPOOL FNP

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	363LF0000X	Family Nurse Practitioner	200471	AK
2	261QU0200X	Urgent Care Clinic/Center		AK

General Provider Information

NPI Number	:	1477224426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LEIOLANI VANDERPOOL FNP

Provider Business Mailing Address
First Line	:	950 E BOGARD RD STE 228
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7185
Country	:	US
Telephone Number	:	907-215-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 E BOGARD RD STE 228
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7185
Country	:	US
Telephone Number	:	907-215-4846
Fax Number	:	907-215-4847

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	04/21/2026

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