Individual
SHANE UDELHOVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
35670 KENAI SPUR HWY STE 103A, SOLDOTNA, AK 99669-7649
(907) 260-1655
(980) 495-8870
Mailing address
48690 TOTE RD, SOLDOTNA, AK 99669-9155
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PADA893
AK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1572984
—
AK
Enumeration date
11/09/2009
Last updated
02/18/2020
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