Church, Lara Diane
Church, Lara Diane is an individual health care provider with primary practice located at 1001 S Knik Goose Bay Rd , Wasilla AK 99654-8083. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Church, Lara Diane can be contacted via phone (907) 631-7800.Contact Information
Primary practice address
1001 S Knik Goose Bay Rd
Wasilla AK 99654-8083
Phone: (907) 631-7800
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ME105548 | Florida |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 204658 | Alaska |
Profile Details
| NPI number | 1043280449 |
|---|---|
| LBN Legal business name | Church, Lara Diane |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 26th, 2006 |
| Last updated | Aug 31st, 2026 - about 2 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043280449 | NPPES |
| Florida | Other | P01431326 | RR MEDICARE |
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