Individual
JESSICA D VAN WULVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3765 E. BLUE LUPINE DR. STE D, WASILLA, AK 99654
(907) 707-1671
(907) 707-1675
Mailing address
3765 E. BLUE LUPINE DR. STE D, WASILLA, AK 99654
(907) 707-1671
(907) 707-1675
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2365
AK
363AM0700X
Medical Physician Assistant
Primary
PADA1218
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1648921
—
AK
Enumeration date
12/01/2014
Last updated
02/02/2024
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