# RESTORATION WELLNESS, LLC

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

## Provider details

- **NPI number:** 1962953810
- **Authorized official:** LYDIA M PETERSEN ANP (OWNER)
- **Authorized official phone:** (907) 376-7300

## Contact information

- **Practice address:** 5805 E COLUMBUS WAY, WASILLA, AK 99654-7831
- **Practice address phone:** (907) 376-7300
- **Mailing address:** PO BOX 876089, WASILLA, AK 99687-6089
- **Mailing address phone:** (907) 376-7300
- **Mailing address fax:** (888) 977-2041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 1042971 | AK | Yes |

## Other

- **Enumeration date:** 10/16/2016
- **Last updated:** 12/30/2016