Provider Demographics
NPI:1558687061
Name:WHITESTONE ENTERPRISES
Entity Type:Organization
Organization Name:WHITESTONE ENTERPRISES
Other - Org Name:WHITESTONE MIDWIFERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-803-0100
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-1229
Mailing Address - Country:US
Mailing Address - Phone:907-895-4938
Mailing Address - Fax:
Practice Address - Street 1:MILE 275 RICHARDSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737
Practice Address - Country:US
Practice Address - Phone:907-895-4938
Practice Address - Fax:907-895-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK54176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNM25421Medicaid