Healthcare Provider Details

I. General information

NPI: 1235468505
Provider Name (Legal Business Name): ARCTIC MIDWIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 GAFFNEY RD STE 100
FAIRBANKS AK
99701-4658
US

IV. Provider business mailing address

728 GAFFNEY RD STE 100
FAIRBANKS AK
99701-4658
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-3719
  • Fax: 907-456-1511
Mailing address:
  • Phone: 907-456-3719
  • Fax: 907-456-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number913507
License Number StateAK

VIII. Authorized Official

Name: VANESSA DUNHAM
Title or Position: MIDWIFE
Credential: CDM, CPM
Phone: 907-456-3719