Provider Demographics
NPI:1235468505
Name:ARCTIC MIDWIVES, LLC
Entity Type:Organization
Organization Name:ARCTIC MIDWIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CDM, CPM
Authorized Official - Phone:907-456-3719
Mailing Address - Street 1:728 GAFFNEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4658
Mailing Address - Country:US
Mailing Address - Phone:907-456-3719
Mailing Address - Fax:907-456-1511
Practice Address - Street 1:728 GAFFNEY RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4658
Practice Address - Country:US
Practice Address - Phone:907-456-3719
Practice Address - Fax:907-456-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK913507176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1174792618Medicaid
AK1497888572Medicaid
AK1568595650Medicaid
AK1639200611Medicaid