Healthcare Provider Details

I. General information

NPI: 1417422510
Provider Name (Legal Business Name): RACHEL ANN PUGH CDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 E NORTHERN LIGHTS BLVD STE 201
ANCHORAGE AK
99508-4150
US

IV. Provider business mailing address

1810 PATTERSON CT
ANCHORAGE AK
99504-2772
US

V. Phone/Fax

Practice location:
  • Phone: 907-691-5991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number126725
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: