Individual
WENCESLOUS FRU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3300 PROVIDENCE DR, SUITE B314, ANCHORAGE, AK 99508-4690
(907) 212-3420
(907) 212-3429
Mailing address
22301 W ALSOP RD, WASILLA, AK 99623-5023
(907) 538-2308
(907) 864-8452
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
114514
AK
Other
Enumeration date
09/11/2015
Last updated
10/14/2020
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