Healthcare Provider Details

I. General information

NPI: 1639271323
Provider Name (Legal Business Name): CHENA OBSTETRICS & GYNECOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST SUITE 222
FAIRBANKS AK
99701-5930
US

IV. Provider business mailing address

1919 LATHROP ST SUITE 222
FAIRBANKS AK
99701-5930
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-8191
  • Fax:
Mailing address:
  • Phone: 907-456-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EILUNED HOGENSON
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 907-456-8191