Individual
ELAINE PONCHIONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP, RN, PSY. A.
Contact information
Practice address
250 CUSHMAN ST STE 3C, FAIRBANKS, AK 99701-4665
(907) 455-7801
(907) 455-7803
Mailing address
250 CUSHMAN ST, SUITE 3C, FAIRBANKS, AK 99701-4640
(907) 455-7801
(907) 455-7803
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
491
AK
163WP0808X
Psychiatric/Mental Health Registered Nurse
4018
AK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1045
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K162139
MEDICARE PTAN
AK
05
—
NP6894
—
AK
Enumeration date
10/24/2006
Last updated
11/14/2011
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