Organization
MEDICAL NETWORK OF ALASKA, LLC
Active
Parent organization
MEDICAL NETWORK OF ALASKA, LLC
Other names
Capstone Dermatology
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Authorized official
JACQUELYN RENEE BLOMKER (DIRECTOR OF REVENUE CYCLE)
(907) 357-9590
Entity
Organization
Contact information
Practice address
3122 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7255
(907) 357-9590
(907) 357-9593
Mailing address
3122 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7255
(907) 357-9590
(907) 357-9593
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137140
STATE OF ALASKA BUSINESS LICENSE
AK
Enumeration date
08/02/2021
Last updated
08/02/2021
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