Provider Demographics
NPI:1538829106
Name:AUTHIER, CALLIE COLLEEN
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:COLLEEN
Last Name:AUTHIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10163 NANTUCKET LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4437
Mailing Address - Country:US
Mailing Address - Phone:907-229-6795
Mailing Address - Fax:
Practice Address - Street 1:4315 DIPLOMACY DRIVE
Practice Address - Street 2:ANCHORAGE
Practice Address - City:ALASKA
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:855-482-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK136922367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered