Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 879 | AK |
NPI | 1083640387 |
---|---|
Provider Name | Michael Thomas Von Ah |
First Address | Wasilla, AK 99654-6760 |
Second Address | Wasilla, AK 99623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP0879 | (05) | AK |