| NPI |
1760044663 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Entity Type Code |
1 |
The country code in the location address of the provider being identified. |
| Provider Last Name Legal Name |
WILLIAMS |
The telephone number associated with the location address of the provider being identified. |
| Provider First Name |
CHELSIE |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Credential Text |
MSW |
The date that a record was last updated or changed. |
| Provider First Line Business Practice Location Address |
8012 STEWART MOUNTAIN DR |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Business Practice Location Address City Name |
EAGLE RIVER |
The first name of the authorized official. |
| Provider Business Practice Location Address State Name |
AK |
The title or position of the authorized official. |
| Provider Business Practice Location Address Postal Code |
995779013 |
The 10-position telephone number of the authorized official. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Business Practice Location Address Telephone Number |
9076943336 |
|
| Provider Enumeration Date |
7/1/2019 |
|
| Last Update Date |
7/30/2020 |
The date that a record was last updated or changed. |
| Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
101Y00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Healthcare Provider Taxonomy Code 2 |
101YA0400X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
| Healthcare Provider Taxonomy Code 3 |
101YM0800X |
|
| Healthcare Provider Primary Taxonomy Switch 3 |
N |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
7/30/2020 |
|