Provider Demographics
NPI:1285833103
Name:ALL SEASONS FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:ALL SEASONS FAMILY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:907-376-4644
Mailing Address - Street 1:5461 E MAYFLOWER LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7817
Mailing Address - Country:US
Mailing Address - Phone:907-376-4644
Mailing Address - Fax:
Practice Address - Street 1:5461 E MAYFLOWER LN
Practice Address - Street 2:SUITE 4
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7817
Practice Address - Country:US
Practice Address - Phone:907-376-4644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0554363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP05542Medicaid
AKNP05541Medicaid
AKNP05542Medicaid