Provider Demographics
NPI:1639200611
Name:CORRICK, CHERYL ANN (CDM)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:CORRICK
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 1:728 GAFFNEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4610
Mailing Address - Country:US
Mailing Address - Phone:907-456-3719
Mailing Address - Fax:
Practice Address - Street 1:728 GAFFNEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4610
Practice Address - Country:US
Practice Address - Phone:907-456-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA21176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAA21OtherSTATE LICENSE NUMBER
AKNM0021Medicaid