Healthcare Provider Details

I. General information

NPI: 1922315597
Provider Name (Legal Business Name): WINDSONG MIDWIFERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 E COLUMBUS WAY
WASILLA AK
99654-7831
US

IV. Provider business mailing address

PO BOX 874553
WASILLA AK
99687-4553
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-2672
  • Fax: 907-373-5417
Mailing address:
  • Phone: 907-373-2672
  • Fax: 907-373-5417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number31
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberFBC-004
License Number StateAK

VIII. Authorized Official

Name: MS. DEBORAH SCHNEIDER
Title or Position: OWNER
Credential: CDM
Phone: 907-373-2672