1063604957 NPI number — IRENE SPIEKER NURSE PRACTITIONER

Table of content: IRENE SPIEKER NURSE PRACTITIONER (NPI 1063604957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063604957 NPI number — IRENE SPIEKER NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPIEKER
Provider First Name:
IRENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPIEKER
Provider Other First Name:
RENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063604957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4050 LAKE OTIS PKWY
Provider Second Line Business Mailing Address:
SUITE #204B WOMENS HEALTHCARE CENTER
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-929-9586
Provider Business Mailing Address Fax Number:
907-929-3836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4050 LAKE OTIS PKWY
Provider Second Line Business Practice Location Address:
SUITE #204B WOMENS HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-929-9586
Provider Business Practice Location Address Fax Number:
907-929-3836
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ANP0136 , 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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