Provider Demographics
NPI:1063020543
Name:FORGET ME NOT HEALTHCARE CLINIC LLC
Entity Type:Organization
Organization Name:FORGET ME NOT HEALTHCARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ATHEA
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:907-351-4060
Mailing Address - Street 1:10261 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 INDEPENDENCE DR STE 1000
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4686
Practice Address - Country:US
Practice Address - Phone:907-351-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty