# JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nell Ann Wagoner, M.D., P.C.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184160905
- **Authorized official:** DR. NICHOLAS D. NEWBURY D.O. (PRESIDENT)
- **Authorized official phone:** (907) 586-1717

## Contact information

- **Practice address:** 3268 HOSPITAL DR, SUITE B, JUNEAU, AK 99801-7800
- **Practice address phone:** (907) 586-1717
- **Practice address fax:** (907) 586-2677
- **Mailing address:** 3268 HOSPITAL DR, SUITE B, JUNEAU, AK 99801-7800
- **Mailing address phone:** (907) 586-1717
- **Mailing address fax:** (907) 586-2677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 107902 | AK | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | MD2531 | AK | — |
| 261QM2500X | Medical Specialty Clinic/Center | NP0168 | AK | — |

## Other

- **Enumeration date:** 01/18/2017
- **Last updated:** 07/29/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1020712 | — | AK |