Organization · NPI-2

Creekside Family Health Clinic INC

Nurse Practitioner, Family · Ketchikan, AK

NPI number1477847184

StatusActive

Last updated in NPPESNov 13, 2012

Details

NPI: 1477847184
Entity type: Organization (NPI-2)
Legal business name: Creekside Family Health Clinic INC
Organization subpart: No
Enumeration date: May 31, 2011
Last updated: Nov 13, 2012

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LF0000X	Nurse Practitioner, Family	–	–	Yes
207Q00000X	Family Medicine	–	–

Practice location

320 Bawden St
Suite #313
Ketchikan, AK 99901-6573

Phone 907-220-9982 · Fax 907-220-9972

Mailing address

3521 Lomita Blvd
Suite #103
Torrance, CA 90505-5039

Phone 310-534-9131 · Fax 310-534-9132

Authorized official

John Hill
Office Manager
9072209982

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