Provider Demographics
NPI:1376966382
Name:DISALVI, CAROL FRANCES
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:FRANCES
Last Name:DISALVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1617
Mailing Address - Country:US
Mailing Address - Phone:907-646-0702
Mailing Address - Fax:907-644-0908
Practice Address - Street 1:959 NORMAN ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1617
Practice Address - Country:US
Practice Address - Phone:907-646-0702
Practice Address - Fax:907-644-0908
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101013171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor