Provider Demographics
NPI:1609990670
Name:DUNTZE, DIANE L (ANP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:DUNTZE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 335
Mailing Address - Street 2:
Mailing Address - City:GAKONA
Mailing Address - State:AK
Mailing Address - Zip Code:99586-9702
Mailing Address - Country:US
Mailing Address - Phone:907-822-3937
Mailing Address - Fax:907-822-3937
Practice Address - Street 1:HC 1 BOX 335
Practice Address - Street 2:
Practice Address - City:GAKONA
Practice Address - State:AK
Practice Address - Zip Code:99586-9702
Practice Address - Country:US
Practice Address - Phone:907-822-3937
Practice Address - Fax:907-822-3937
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP02473Medicaid
AK02D1010983OtherCLIA#
AK686OtherANP LICENSE #
AKNP02472Medicaid
AKNP02471Medicaid
AKPH02473Medicaid
AK11406OtherREGISTERED NURSE
AKK151740OtherMEDICARE PTAN
AKNP0247Medicaid
AKNP0247Medicaid
AKK151740OtherMEDICARE PTAN