Individual
SHANNON LEE RUTH DIEFFENDERFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 LAKE OTIS PKWY STE 108, ANCHORAGE, AK 99508-5230
(907) 563-3145
(907) 561-3967
Mailing address
4100 LAKE OTIS PKWY STE 108, ANCHORAGE, AK 99508-5230
(907) 563-3145
(907) 561-3967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10117
GA
363A00000X
Physician Assistant
Primary
172156
AK
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
08/17/2019
Last updated
06/06/2022
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