| NPI | 1841814795 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP ALASKA |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary For Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |