Provider Demographics
NPI:1205923570
Name:HORNER, MAUREEN ANN (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANN
Last Name:HORNER
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:2621 CURLEW CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1656
Mailing Address - Country:US
Mailing Address - Phone:907-952-0770
Mailing Address - Fax:907-563-9185
Practice Address - Street 1:207 E NORTHERN LIGHTS BLVD STE 208
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2731
Practice Address - Country:US
Practice Address - Phone:907-952-0770
Practice Address - Fax:907-644-3221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP9201Medicaid
AK152506Medicare UPIN