Basic Information
Provider Information
NPI: 1568108587
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WESTBURY
FirstName: ROSE
MiddleName: ADRIANA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 245 N BINKLEY ST STE 202
Address2:  
City: SOLDOTNA
State: AK
PostalCode: 996697500
CountryCode: US
TelephoneNumber: 9077144521
FaxNumber: 9072604063
Practice Location
Address1: 354 TYEE ST
Address2:  
City: SOLDOTNA
State: AK
PostalCode: 996697657
CountryCode: US
TelephoneNumber: 9077144521
FaxNumber: 9072604063
Other Information
ProviderEnumerationDate: 05/11/2022
LastUpdateDate: 05/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X171530AKY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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