Provider Demographics
NPI:1164479374
Name:HORSWILL-WOODS, LOETTA MAE (DO)
Entity Type:Individual
Prefix:DR
First Name:LOETTA
Middle Name:MAE
Last Name:HORSWILL-WOODS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 E MERIDIAN LOOP
Mailing Address - Street 2:SUITE F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7270
Mailing Address - Country:US
Mailing Address - Phone:907-373-5940
Mailing Address - Fax:907-373-5947
Practice Address - Street 1:3719 E MERIDIAN LOOP
Practice Address - Street 2:SUITE F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7270
Practice Address - Country:US
Practice Address - Phone:907-373-5940
Practice Address - Fax:907-373-5947
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5445Medicaid
AKMD5445Medicaid
AKK151866Medicare PIN