Healthcare Provider Details

I. General information

NPI: 1174153910
Provider Name (Legal Business Name): THE COTTAGE, WOMEN & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W 9TH AVE
ANCHORAGE AK
99501-3519
US

IV. Provider business mailing address

445 W 9TH AVE
ANCHORAGE AK
99501-3519
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-6655
  • Fax: 907-313-2376
Mailing address:
  • Phone: 907-770-6655
  • Fax: 907-313-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LENA MCGINNIS-KILIC
Title or Position: OWNER / MIDWIFER
Credential: CDM
Phone: 907-770-6655