# GLACIER BAY MEDICAL AND DIABETES CARE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518515030
- **Authorized official:** MRS. ADRIENNE JOHNSON MSN, APRN, NP-C (OWNER/MANAGING MEMBER)
- **Authorized official phone:** (907) 952-2296

## Contact information

- **Practice address:** 1200 AIRPORT HEIGHTS DR STE 240, ANCHORAGE, AK 99508-2970
- **Practice address phone:** (907) 290-4666
- **Practice address fax:** (907) 921-5151
- **Mailing address:** 5598 KENAI FJORDS LOOP, ANCHORAGE, AK 99502-4047
- **Mailing address phone:** (907) 290-4666
- **Mailing address fax:** (907) 921-5151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2019
- **Last updated:** 10/21/2024