| Organization Name: | GREATLAND WOMEN'S HEALTCARE, LLC |
| NPI Number: | 1013378744 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL VON AH (WOMEN'S HEALTH NURSE PRACTITIONER) |
| Mailing Address: | 5805 E Columbus Way Wasilla |
| State: | AK US |
| Postal Code: | 996547831 |
| Phone Number: | 9073735400 |
| Fax Number: | 9073735417 |
| NPI Enumeration Date: | 03/08/2016 |
| NPI Last Update Date: | 03/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WW0101X |
| License Number: | 879 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Women's Health Care, Ambulatory |
| Taxonomy Definition: | |