Individual
LEILANI CAROL DISSELKOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7010 E BOGARD RD, WASILLA, AK 99654-4711
(907) 373-4732
Mailing address
17641 BEAUJOLAIS DR, EAGLE RIVER, AK 99577-7515
(907) 373-4732
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/18/2025
Last updated
09/18/2025
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