Restoration Wellness, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

1042971 Issued in AK

Legal business name

RESTORATION WELLNESS, LLC

Practice address

5805 E Columbus Way
Wasilla, AK 99654-7831

Phone

(907) 376-7300

NPI assigned

Oct 16, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lydia M Petersen, ANP

Title

Owner

Phone

(907) 376-7300

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483056000000",
    "number": "1962953810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 876089",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996876089",
            "telephone_number": "907-376-7300",
            "fax_number": "888-977-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5805 E COLUMBUS WAY",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547831",
            "telephone_number": "907-376-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-16",
        "last_updated": "2016-12-30",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-376-7300",
        "authorized_official_credential": "ANP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AK",
            "license": "1042971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Primary Care Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.