Provider Demographics
NPI:1356821540
Name:WEBSTER, TANECIA (NP)
Entity Type:Individual
Prefix:
First Name:TANECIA
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36570 KENAI SPUR HWY
Mailing Address - Street 2:STE 103A
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:907-260-1655
Mailing Address - Fax:855-854-8577
Practice Address - Street 1:36570 KENAI SPUR HWY
Practice Address - Street 2:STE 103A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-260-1655
Practice Address - Fax:855-854-8577
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK136045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner