| Organization Name: | OLGA IRIS WASILE |
| NPI Number: | 1134258247 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE E HODGES (OFFICE MANAGER) |
| Mailing Address: | 20905 Eastside Dr #1 Chugiak |
| State: | AK US |
| Postal Code: | 995671249 |
| Phone Number: | 9076880901 |
| Fax Number: | 9076880830 |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |