| NPI | 1710799028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT WALL Executive Director 907-983-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2025-01-23 |
| Last Update Date | 2025-07-30 |