Provider Demographics
NPI:1558845958
Name:WIRUM, MASLIN
Entity Type:Individual
Prefix:
First Name:MASLIN
Middle Name:
Last Name:WIRUM
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 1:2836 KIMBERLIE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5329
Mailing Address - Country:US
Mailing Address - Phone:907-349-4222
Mailing Address - Fax:
Practice Address - Street 1:2836 KIMBERLIE CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5329
Practice Address - Country:US
Practice Address - Phone:907-349-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other