Provider Demographics
NPI:1902184203
Name:D.L.DOORNBOS FNP-BC, MSN, LLC
Entity Type:Organization
Organization Name:D.L.DOORNBOS FNP-BC, MSN, LLC
Other - Org Name:HOLISTIC HEALTH CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOORNBOS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC MSN
Authorized Official - Phone:907-242-7384
Mailing Address - Street 1:3970 STELLER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4225
Mailing Address - Country:US
Mailing Address - Phone:907-242-7384
Mailing Address - Fax:
Practice Address - Street 1:3970 STELLER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4225
Practice Address - Country:US
Practice Address - Phone:907-242-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK960196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty