MEDICARE: ANN MARIE LOFGREEN

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	174400000X	Specialist	107273	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12503896	OTHER	AK	CAQH

General Provider Information

NPI Number	:	1619244100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE LOFGREEN

Provider Business Mailing Address
First Line	:	PO BOX 879382
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-9382
Country	:	US
Telephone Number	:	907-414-5803
Fax Number	:	888-241-1318

Provider Business Practice Location Address
First Line	:	432 S ALASKA ST
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-6338
Country	:	US
Telephone Number	:	907-414-5803
Fax Number	:	888-241-1318

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	05/10/2018

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Directions to “ ANN MARIE LOFGREEN ” Practice Location

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