Healthcare Provider Details

I. General information

NPI: 1861382749
Provider Name (Legal Business Name): ORIGIN STORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 W 6TH AVE
ANCHORAGE AK
99501-1909
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 Number
License Number StateNULL

VIII. Authorized Official

Name: STELLA LYN
Title or Position: MIDWIFE
Credential: CPM, CDM, LDM, CLC
Phone: 541-261-3537