Provider Demographics
NPI:1275087397
Name:YANAGAWA, MARY (CDM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:YANAGAWA
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 S SNODGRASS DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9149
Mailing Address - Country:US
Mailing Address - Phone:907-357-7781
Mailing Address - Fax:
Practice Address - Street 1:780 S SNODGRASS DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9149
Practice Address - Country:US
Practice Address - Phone:907-357-7781
Practice Address - Fax:907-357-7786
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104945176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife