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General NPI Number Information
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NPI Number | 1578952586
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Entity Type | Organization
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Legal Business Name | TWO BEAR MIDWIFERY SERVICE, LLC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 3550 AIRPORT WAY STE. 4
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City | FAIRBANKS
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State | AK
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Zip | 99709-4772
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Country | US
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Telephone | 907-978-2868
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Fax | 907-488-6098
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Provider Business Mailing Address
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Address Line | PO BOX 10250
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City | FAIRBANKS
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State | AK
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Zip | 99710-0250
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Country | US
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Telephone | 907-978-2868
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Fax | 907-488-6098
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Authorized Official
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Title or Position | OWNER/ MIDWIFE
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Name | VANESSA RACHEL JACKSON
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Credential | CDM, CPM
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Telephone | 907-978-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 42
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License Number State | AK
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