Provider Demographics
NPI:1861976177
Name:AWAKEN JOY LLC
Entity type:Organization
Organization Name:AWAKEN JOY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DONOFRY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:907-328-0820
Mailing Address - Street 1:565 UNIVERSITY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3687
Mailing Address - Country:US
Mailing Address - Phone:907-328-0820
Mailing Address - Fax:907-328-0850
Practice Address - Street 1:565 UNIVERSITY AVE STE 1
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3687
Practice Address - Country:US
Practice Address - Phone:907-328-0820
Practice Address - Fax:907-328-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty