Healthcare Provider Details

I. General information

NPI: 1023375383
Provider Name (Legal Business Name): ONICA SPROKKREEFF CDM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 E VALLEY CIR SUITE #6
PALMER AK
99645-5929
US

IV. Provider business mailing address

7200 E VALLEY CIR SUITE #6
PALMER AK
99645-5929
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-6644
  • Fax: 186-689-6140
Mailing address:
  • Phone: 907-746-6644
  • Fax: 186-689-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number71
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: