Provider Demographics
NPI:1407195522
Name:FRONTIER FAMILY MEDICINE
Entity Type:Organization
Organization Name:FRONTIER FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-373-3940
Mailing Address - Street 1:300 W SWANSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6844
Mailing Address - Country:US
Mailing Address - Phone:907-373-3940
Mailing Address - Fax:907-373-3948
Practice Address - Street 1:300 W SWANSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6844
Practice Address - Country:US
Practice Address - Phone:907-373-3940
Practice Address - Fax:907-373-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK966034261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK165999Medicare UPIN