Organization
LEGACY HEALTH CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN R KLEIN FNP (OWNER)
(907) 225-6355
Entity
Organization
Contact information
Practice address
3524 TONGASS AVE, KETCHIKAN, AK 99901-5635
(907) 225-6355
Mailing address
3524 TONGASS AVE, KETCHIKAN, AK 99901-5635
(907) 225-6355
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1106
AK
363LF0000X
Family Nurse Practitioner
551
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022301
—
AK
05
—
1580081
—
AK
Enumeration date
10/01/2015
Last updated
10/01/2015
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