Provider Demographics
NPI:1558551259
Name:WRIGHTSMAN-BIRCH, STEPHANIE GRACE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GRACE
Last Name:WRIGHTSMAN-BIRCH
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 1:6307 DEBARR RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1701
Mailing Address - Country:US
Mailing Address - Phone:907-333-7425
Mailing Address - Fax:907-333-7719
Practice Address - Street 1:6307 DEBARR RD
Practice Address - Street 2:SUITE C
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1701
Practice Address - Country:US
Practice Address - Phone:907-333-7425
Practice Address - Fax:907-333-7719
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1730113739OtherGROUP NPI
AKEINOther743109721