Provider Demographics
NPI:1083618334
Name:WECKWERTH, ALYCE LYNNE (ANP)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:LYNNE
Last Name:WECKWERTH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 STEELE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-2702
Mailing Address - Country:US
Mailing Address - Phone:907-457-4475
Mailing Address - Fax:
Practice Address - Street 1:3100 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7516
Practice Address - Country:US
Practice Address - Phone:907-452-6251
Practice Address - Fax:907-451-6251
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK493363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner