1093736365 NPI number — MS. JANETTE PETERSON ADASIAK ANP

Table of content: MS. JANETTE PETERSON ADASIAK ANP (NPI 1093736365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093736365 NPI number — MS. JANETTE PETERSON ADASIAK ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADASIAK
Provider First Name:
JANETTE
Provider Middle Name:
PETERSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADASIAK
Provider Other First Name:
JAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093736365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 CRESCENT 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:
99508-5117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-562-0401
Provider Business Mailing Address Fax Number:
907-563-4854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 E 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-274-0352
Provider Business Practice Location Address Fax Number:
907-274-3429
Provider Enumeration Date:
07/22/2006

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: 363LP0808X , with the licence number:  266 , 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)

  • Identifier: NP70111 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150622 . This is a "TRANSAMERICA BILLING CODE" identifier . This identifiers is of the category "OTHER".




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