Healthcare Provider Details

I. General information

NPI: 1639200611
Provider Name (Legal Business Name): CHERYL ANN CORRICK CDM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 GAFFNEY RD SUITE 100
FAIRBANKS AK
99701-4610
US

IV. Provider business mailing address

728 GAFFNEY RD SUITE 100
FAIRBANKS AK
99701-4610
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAA21
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: