Provider Demographics
NPI:1629140629
Name:LIDDELOW-THOMPSON, CATHERINE (ANP)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:LIDDELOW-THOMPSON
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 1:2841 DEBARR RD STE 25
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2967
Mailing Address - Country:US
Mailing Address - Phone:907-336-3500
Mailing Address - Fax:907-264-2336
Practice Address - Street 1:2841 DEBARR RD STE 25
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2967
Practice Address - Country:US
Practice Address - Phone:907-336-3500
Practice Address - Fax:907-264-2336
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP14021Medicaid
AKNP14021Medicaid
AKS91824Medicare UPIN