Provider Demographics
NPI:1083887749
Name:LANFEAR, JEOFFREY WALTER (FNP)
Entity Type:Individual
Prefix:MR
First Name:JEOFFREY
Middle Name:WALTER
Last Name:LANFEAR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-8624
Mailing Address - Fax:
Practice Address - Street 1:44604 STERLING HWY STE D
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7962
Practice Address - Country:US
Practice Address - Phone:907-420-0585
Practice Address - Fax:907-420-0586
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUR U 1026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP1026Medicaid
AKK162058Medicare PIN