Provider Demographics
NPI:1619045267
Name:ANDERSON, ANN FEIGE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:FEIGE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:FEIGE
Other - Last Name:RESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 2744
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2744
Mailing Address - Country:US
Mailing Address - Phone:907-235-7000
Mailing Address - Fax:907-235-4050
Practice Address - Street 1:4201 BARTLETT ST STE 202
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7015
Practice Address - Country:US
Practice Address - Phone:907-235-7000
Practice Address - Fax:907-235-4050
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKS16169Medicare UPIN
AK097WCRBGAMedicare ID - Type UnspecifiedMEDICARE KACHEMAK BAY MED