Individual
MS. KATHERINE GRACE VAN ATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, CNM
Contact information
Practice address
5000 E SHENNUM DR, WASILLA, AK 99654-7718
(907) 373-3420
(907) 376-7847
Mailing address
5000 E SHENNUM DR, WASILLA, AK 99654-7718
(907) 373-3420
(907) 376-7847
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
879
AK
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDA0205
—
AK
Enumeration date
12/01/2006
Last updated
02/19/2024
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