Organization
WASILLA INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
METTESSA MAYE REID (ADMINISTRATOR)
(907) 250-3482
Entity
Organization
Contact information
Practice address
3719 E MERIDIAN LOOP STE F, WASILLA, AK 99654-7273
(907) 373-5940
(907) 373-5947
Mailing address
3719 E MERIDIAN LOOP STE F, WASILLA, AK 99654-7273
(907) 373-5940
(907) 373-5947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD5445
—
AK
Enumeration date
08/20/2019
Last updated
08/20/2019
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