1093821415 NPI number — LEEANNE K MERCIER ANP

Table of content: LEEANNE K MERCIER ANP (NPI 1093821415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093821415 NPI number — LEEANNE K MERCIER ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCIER
Provider First Name:
LEEANNE
Provider Middle Name:
K
Provider Name Prefix Text:
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:
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:
1093821415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 LAKE OTIS PKWY STE 105
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:
99508-5226
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:
4200 LAKE OTIS PKWY STE 105
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:
99508-5226
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:
08/21/2006

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: 363LW0102X , with the licence number:  235 , 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: NP18893 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".