Provider Demographics
NPI:1578952586
Name:TWO BEAR MIDWIFERY SERVICE, LLC
Entity Type:Organization
Organization Name:TWO BEAR MIDWIFERY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDM, CPM
Authorized Official - Phone:907-978-2868
Mailing Address - Street 1:PO BOX 10250
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99710-0250
Mailing Address - Country:US
Mailing Address - Phone:907-978-2868
Mailing Address - Fax:907-488-6098
Practice Address - Street 1:3550 AIRPORT WAY
Practice Address - Street 2:STE. 4
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4772
Practice Address - Country:US
Practice Address - Phone:907-978-2868
Practice Address - Fax:907-488-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK42176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty