Provider Demographics
NPI:1437315058
Name:MITTELSTEADT, GEOFFREY JOHN (APRN)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:JOHN
Last Name:MITTELSTEADT
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3841 PIPER ST STE T100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4674
Mailing Address - Country:US
Mailing Address - Phone:907-561-3211
Mailing Address - Fax:907-561-4652
Practice Address - Street 1:3841 PIPER ST STE T100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4674
Practice Address - Country:US
Practice Address - Phone:907-561-3211
Practice Address - Fax:907-561-4652
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16381363LA2100X
AK203541363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care