1760852388 NPI number — VITAE INTEGRATIVE MEDICAL CENTER

Table of content: PAULA GRIFFIN CERTIFIED NURSE AIDE (NPI 1588173538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760852388 NPI number — VITAE INTEGRATIVE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAE INTEGRATIVE MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760852388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4111 ROMANZOF CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99517-1492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-441-5568
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 DEBARR RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-441-5568
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SAGAN
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
KNOBEL
Authorized Official Title or Position:
NURSE PRACTITIONER, OWNER
Authorized Official Telephone Number:
907-441-5568

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  986 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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