Provider Demographics
NPI:1366119323
Name:AK EMPOWER MEDICAL AND WELLNESS LLC
Entity type:Organization
Organization Name:AK EMPOWER MEDICAL AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-315-4042
Mailing Address - Street 1:1401 S SEWARD MERIDIAN PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8312
Mailing Address - Country:US
Mailing Address - Phone:907-315-4042
Mailing Address - Fax:907-531-7375
Practice Address - Street 1:1401 S SEWARD MERIDIAN PKWY STE D
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8312
Practice Address - Country:US
Practice Address - Phone:907-315-4042
Practice Address - Fax:907-531-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5453129OtherDEA