=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356553655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA KORN ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3650 LAKE OTIS PKWY SUITE 140
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-5207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-277-2597
-----------------------------------------------------
Fax | 907-277-2598
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3650 LAKE OTIS PKWY SUITE 140
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-5207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-277-2597
-----------------------------------------------------
Fax | 907-277-2598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 09
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
=====================================================
Legacy Identifiers
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | NM0199
-----------------------------------------------------
Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | AK
-----------------------------------------------------
Identifier Issuer |
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | NM0199
-----------------------------------------------------
Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | AK
-----------------------------------------------------
Identifier Issuer |
-----------------------------------------------------