Provider Demographics
NPI:1659629087
Name:ALASKA FOOT CARE NURSES, LLC
Entity Type:Organization
Organization Name:ALASKA FOOT CARE NURSES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DEVILLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-250-4412
Mailing Address - Street 1:PO BOX 874263
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4263
Mailing Address - Country:US
Mailing Address - Phone:907-250-4412
Mailing Address - Fax:
Practice Address - Street 1:991 N HERMON SUITE 100
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-250-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18544251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health