Organization
LISA COONEY, MD-PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MARIE COONEY M.D. (OWNER/PHYSICIAN)
(907) 376-1633
Entity
Organization
Contact information
Practice address
1751 GARDNER WAY, SUITE E, WASILLA, AK 99654-6513
(907) 376-1633
(907) 376-7864
Mailing address
1751 E. GARDNER WAY, SUITE E, WASILLA, AK 99654
(907) 376-1633
(907) 376-7864
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3925
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD3925
—
AK
01
—
P0157517
RRMEDICARE
—
Enumeration date
07/11/2006
Last updated
08/22/2020
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