Healthcare Provider Details

I. General information

NPI: 1457626046
Provider Name (Legal Business Name): LENA MCGINNIS-KILIC CDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 E VALLEY CIR STE 6
PALMER AK
99645-5929
US

IV. Provider business mailing address

7200 E VALLEY CIR STE 6
PALMER AK
99645-5929
US

V. Phone/Fax

Practice location:
  • Phone: 907-382-0625
  • Fax:
Mailing address:
  • Phone: 907-382-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number70
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: