Healthcare Provider Details

I. General information

NPI: 1194305730
Provider Name (Legal Business Name): SANTHIA LISA ROSE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3300
  • Fax: 907-729-8997
Mailing address:
  • Phone: 907-729-6799
  • Fax: 907-729-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number172837
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number172837
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN11043495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: