Provider Demographics
NPI:1700028727
Name:ANNE MARIE ZACK, ANP,CO,APC
Entity Type:Organization
Organization Name:ANNE MARIE ZACK, ANP,CO,APC
Other - Org Name:ANNE MARIE ZACK, ANP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ZACK
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-770-6092
Mailing Address - Street 1:PO BOX 211693
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-1693
Mailing Address - Country:US
Mailing Address - Phone:907-770-6092
Mailing Address - Fax:907-770-6039
Practice Address - Street 1:1407 W 31ST AVE
Practice Address - Street 2:STE.201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3678
Practice Address - Country:US
Practice Address - Phone:907-770-6092
Practice Address - Fax:907-770-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK330363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMPG0105Medicaid
AKNP42212Medicaid