Healthcare Provider Details

I. General information

NPI: 1396478129
Provider Name (Legal Business Name): STACEY VIGILANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 SAWMILL CREEK RD
SITKA AK
99835-9712
US

IV. Provider business mailing address

2515 SAWMILL CREEK RD
SITKA AK
99835-9712
US

V. Phone/Fax

Practice location:
  • Phone: 907-314-0463
  • Fax:
Mailing address:
  • Phone: 907-314-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number194925
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: