Provider Demographics
NPI:1932542552
Name:DIABETES SELF MANAGEMENT CONSULTANTS
Entity Type:Organization
Organization Name:DIABETES SELF MANAGEMENT CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:SOLESBEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CDE
Authorized Official - Phone:907-486-0466
Mailing Address - Street 1:PO BOX 8844
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-8844
Mailing Address - Country:US
Mailing Address - Phone:907-486-0466
Mailing Address - Fax:907-486-2907
Practice Address - Street 1:2490 SPRUCE CAPE RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6614
Practice Address - Country:US
Practice Address - Phone:907-486-0466
Practice Address - Fax:907-486-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK294133V00000X
AK22551163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty