Provider Demographics
NPI:1811469539
Name:SEVERSON, TODD LEE
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:LEE
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-0101
Mailing Address - Country:US
Mailing Address - Phone:907-317-5050
Mailing Address - Fax:
Practice Address - Street 1:8531 LITTLE DIPPER AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4238
Practice Address - Country:US
Practice Address - Phone:907-222-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion