Provider Demographics
NPI:1598420341
Name:ALIVIA INTEGRATIVE WOMEN'S HEALTH & MIDWIFERY LLC
Entity Type:Organization
Organization Name:ALIVIA INTEGRATIVE WOMEN'S HEALTH & MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DECONTO
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:503-953-5174
Mailing Address - Street 1:202 CENTER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7307
Mailing Address - Country:US
Mailing Address - Phone:202-964-0278
Mailing Address - Fax:
Practice Address - Street 1:202 CENTER AVE STE 206
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7307
Practice Address - Country:US
Practice Address - Phone:202-964-0278
Practice Address - Fax:855-794-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty