Provider Demographics
NPI:1073847943
Name:CYNTHIA EBELACKER, ANP
Entity Type:Organization
Organization Name:CYNTHIA EBELACKER, ANP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBELACKER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-632-7577
Mailing Address - Street 1:1407 W 31ST AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3678
Mailing Address - Country:US
Mailing Address - Phone:907-646-9948
Mailing Address - Fax:907-646-9949
Practice Address - Street 1:1407 W 31ST AVE
Practice Address - Street 2:STE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3678
Practice Address - Country:US
Practice Address - Phone:907-646-9948
Practice Address - Fax:907-646-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK435363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG0090Medicaid