Organization
ALASKA MIGRAINE SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY BORTON (OFFICE MANAGER)
(907) 331-9835
Entity
Organization
Contact information
Practice address
13135 OLD GLENN HWY STE 100, EAGLE RIVER, AK 99577-7584
(907) 331-9835
Mailing address
PO BOX 670601, CHUGIAK, AK 99567-0601
(907) 331-9835
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123184
BUSINESS LICENSE
AK
Enumeration date
12/20/2021
Last updated
02/21/2022
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