Provider Demographics
NPI:1225259096
Name:TERWILLIGER, SUSAN KAY (LM,CPM,CDM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:TERWILLIGER
Suffix:
Gender:F
Credentials:LM,CPM,CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11517 OLD GLENN HIGHWAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7312
Mailing Address - Country:US
Mailing Address - Phone:907-694-1123
Mailing Address - Fax:907-694-6363
Practice Address - Street 1:11517 OLD GLENN HIGHWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7312
Practice Address - Country:US
Practice Address - Phone:907-694-1123
Practice Address - Fax:907-694-6363
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK47176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNM8398Medicaid