Organization
JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Active
Other names
Nell Ann Wagoner, M.D., P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS D. NEWBURY D.O. (PRESIDENT)
(907) 586-1717
Entity
Organization
Contact information
Practice address
3268 HOSPITAL DR, SUITE B, JUNEAU, AK 99801-7800
(907) 586-1717
(907) 586-2677
Mailing address
3268 HOSPITAL DR, SUITE B, JUNEAU, AK 99801-7800
(907) 586-1717
(907) 586-2677
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
107902
AK
261QA1903X
Ambulatory Surgical Clinic/Center
MD2531
AK
261QM2500X
Medical Specialty Clinic/Center
NP0168
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020712
—
AK
Enumeration date
01/18/2017
Last updated
07/29/2017
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