MOOSE CREEK MEDICAL CLINIC LLC NPI 1053883595

NPI Information

MOOSE CREEK MEDICAL CLINIC LLC is an adult health nurse practitioner in Wasilla, AK. MOOSE CREEK MEDICAL CLINIC LLC NPI is 1053883595. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2341 S. FERN ST., SUITE 300
WASILLA, AK
ZIP 99654
Phone: (907) 373-3335
Fax: (907) 373-3331

The provider's authorized official is Kimberli Raye Brock .
The authorized official title is Advanced Nurse Practitioner, Busine and has the following contact phone number (907) 373-3335.

The CLIA number assigned to this NPI record is 02D2165694 - other practitioner with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/21/2018 and was last updated on 12/21/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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