Healthcare Provider Details

I. General information

NPI: 1396054615
Provider Name (Legal Business Name): STELLA LYN CPM, CDM, CLC, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 90058
ANCHORAGE AK
99509-0058
US

IV. Provider business mailing address

PO BOX 90058
ANCHORAGE AK
99509-0058
US

V. Phone/Fax

Practice location:
  • Phone: 541-261-3537
  • Fax:
Mailing address:
  • Phone: 541-261-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number258626
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: