Provider Demographics
NPI:1124249164
Name:WILLARD, ANNE (FNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 37028
Mailing Address - Street 2:
Mailing Address - City:TOKSOOK BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 TOKSOOK BAY SUB-REGIONAL CLINIC
Practice Address - Street 2:
Practice Address - City:TOKSOOK BAY
Practice Address - State:AK
Practice Address - Zip Code:99637
Practice Address - Country:US
Practice Address - Phone:907-543-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23973163W00000X
AK816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0816Medicaid
AKNP0816Medicaid