Healthcare Provider Details

I. General information

NPI: 1740661677
Provider Name (Legal Business Name): ERIN ELIZABETH KEIPER A.P.R.N., C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ELIZABETH JOHNSON A.P.R.N., C.N.M.

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 30TH AVE
FAIRBANKS AK
99701-7316
US

IV. Provider business mailing address

2054 30TH AVE
FAIRBANKS AK
99701-7316
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 TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number100320
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number100320
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: