Healthcare Provider Details

I. General information

NPI: 1447577325
Provider Name (Legal Business Name): KRISTIN HOCK CDM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SALMON CREEK LN
JUNEAU AK
99801-7867
US

IV. Provider business mailing address

1601 SALMON CREEK LN
JUNEAU AK
99801-7867
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-1203
  • Fax: 907-586-5765
Mailing address:
  • Phone: 907-586-1203
  • Fax: 907-586-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number65
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: