Organization
WILD IRIS LLC
Active
Other names
Wild Iris Family Medicine and Maternity Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA HARRISON M.D. (OWNER/PHYSICIAN)
(907) 373-9463
Entity
Organization
Contact information
Practice address
851 E WESTPOINT DR, SUITE 207, WASILLA, AK 99654-7183
(907) 373-9463
Mailing address
851 E WESTPOINT DR, SUITE 207, WASILLA, AK 99654-7183
(907) 373-9463
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5448
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012605
—
AK
Enumeration date
10/25/2013
Last updated
10/20/2014
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