RESTORATION WELLNESS LLC NPI 1962953810

NPI Information

NPI: 1962953810
Provider Name: RESTORATION WELLNESS, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 02D2122722

Address:
5805 E COLUMBUS WAY
WASILLA, AK
ZIP 99654
Phone: (907) 376-7300
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RESTORATION WELLNESS, LLC is a primary care clinic center in Wasilla, AK. RESTORATION WELLNESS, LLC NPI is 1962953810. The provider is registered as an organization entity type.

The provider's business location address is:

5805 E COLUMBUS WAY
WASILLA, AK
ZIP 99654-831
Phone: (907) 376-7300

The provider's authorized official is Lydia M Petersen .
The authorized official title is Owner and has the following contact phone number (907) 376-7300.

The CLIA number assigned to this NPI record is 02D2122722 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/16/2016 and was last updated on 12/30/2016.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	1042971	ALASKA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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