Wild Iris Llc

NPI 1003244211 - Family Medicine - 207Q00000X

NPI Details
NPI 1003244211
Enumeration Date 10/25/2013
Last Updated 10/20/2014
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name LISA LISA
Position OWNER/PHYSICIAN
Phone (907) 373-9463
Fax
Practice Location
851 E WESTPOINT DR
SUITE 207
WASILLA AK, 99654-7183, US
Phone (907) 373-9463
Fax
Business Location
851 E WESTPOINT DR
SUITE 207
WASILLA AK, 99654-7183, US
Phone (907) 373-9463
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State Alaska
License Number 5448
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According to our database, Wild Iris Llc NPI is 1003244211, taxonomy code is 207Q00000X and license number is 5448, license state is located at Alaska. Wild Iris Llc physically located at 851 E Westpoint Dr, Wasilla AK, 99654-7183. NPI Number 1033115704 has the healthcare provider type.

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1003244211 NPI number is provided on an as is basis without warranty of any kind. 1003244211 is maintained by the National Plan & Provider Enumeration System. The contents of Wild Iris Llc are for informational purposes only.