Organization
ADVANCED WELLNESS INFUSION CENTER, LLC
Active
Other names
Hydrate Alaska
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANIEL L EASTMAN MD (OWNER/PROVIDER)
(907) 980-1186
Entity
Organization
Contact information
Practice address
5805 E COLUMBUS WAY, WASILLA, AK 99654-7831
(907) 929-4825
Mailing address
5805 E COLUMBUS WAY, WASILLA, AK 99654-7831
(907) 929-4825
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MEDS5780
STATE OF ALASKA MEDICAL LICENSE
AK
Enumeration date
09/15/2021
Last updated
03/07/2023
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