Organization
ALLIED CLINIC & WOUNDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY M KIDAVAYI APRN (CEO)
(702) 601-1360
Entity
Organization
Contact information
Practice address
1577 C ST STE 878616, ANCHORAGE, AK 99501-5127
(702) 983-6674
Mailing address
1577 C ST STE 878616, ANCHORAGE, AK 99501-5127
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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