Provider Demographics
NPI:1669496709
Name:POWELL, ANITA B (ANP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:POWELL
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 1:4115 LAKE OTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-563-7228
Mailing Address - Fax:907-563-6278
Practice Address - Street 1:3260 PROVIDENCE DR STE 322
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-563-5151
Practice Address - Fax:907-562-6995
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK182363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP01822Medicaid
AKNP01824Medicaid
AKNP0182Medicaid
AKS94184Medicare UPIN
AK161524Medicare PIN
AK151141Medicare ID - Type Unspecified