Provider Demographics
NPI:1992932503
Name:WOMEN'S HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:WOMEN'S HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCIER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-929-9586
Mailing Address - Street 1:4050 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 204 B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5223
Mailing Address - Country:US
Mailing Address - Phone:907-929-9586
Mailing Address - Fax:907-929-3836
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 204 B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-929-9586
Practice Address - Fax:907-929-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP-18893Medicaid