Southcentral Foundation

NPI #1689194250 in Wasilla, Alaska

Provider Information

NPI Number: 1689194250
Entity Type: Organization
Organization Name: Southcentral Foundation
Primary Specialty: Dietitian, Registered
Enumeration Date: Jun 23, 2017
Last Updated: Jun 23, 2017

Practice Location

Address: 1001 S KNIK GOOSE BAY RD
City: Wasilla
State: Alaska
ZIP Code: 99654-8083
Phone: (907) 729-8624

Authorized Official

Name: RONALD LEE OLSON
Title: VP OF FINANCE
Phone: (907) 729-8624

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietitian, Registered	133V00000X	Primary

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