Provider Demographics
NPI:1649629163
Name:UNIVERSITY OF ALASKA - ANCHORAGE
Entity type:Organization
Organization Name:UNIVERSITY OF ALASKA - ANCHORAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ANP,
Authorized Official - Phone:907-786-4048
Mailing Address - Street 1:3211 PROVIDENCE DR # RH120
Mailing Address - Street 2:STUDENT HEALTH & COUNSELING CENTER
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4614
Mailing Address - Country:US
Mailing Address - Phone:907-786-4048
Mailing Address - Fax:
Practice Address - Street 1:3211 PROVIDENCE DR # RH120
Practice Address - Street 2:STUDENT HEALTH & COUNSELING CENTER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4614
Practice Address - Country:US
Practice Address - Phone:907-786-4048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ALASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109774261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health