Provider Demographics
NPI:1750594818
Name:RESTAD, JOYCE CAMILLE (DO)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:CAMILLE
Last Name:RESTAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:CAMILLE
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5461 MAYFLOWER
Mailing Address - Street 2:#4
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-376-4644
Mailing Address - Fax:907-376-4690
Practice Address - Street 1:5461 MAYFLOWER
Practice Address - Street 2:#4
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-376-4644
Practice Address - Fax:907-376-4690
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine