Provider Demographics
NPI:1316093321
Name:ELDER, AMY (ANP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874779
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4779
Mailing Address - Country:US
Mailing Address - Phone:907-521-5052
Mailing Address - Fax:
Practice Address - Street 1:851 E WESTPOINT DR STE 301
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7183
Practice Address - Country:US
Practice Address - Phone:907-982-7821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK560363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022503Medicaid
AKS88233Medicare UPIN
AK151209Medicare ID - Type Unspecified