Provider Demographics
NPI:1679228837
Name:PRISM MIDWIFERY LLC
Entity Type:Organization
Organization Name:PRISM MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:CDM
Authorized Official - Phone:907-723-5775
Mailing Address - Street 1:3845 N DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-6468
Mailing Address - Country:US
Mailing Address - Phone:907-723-5775
Mailing Address - Fax:505-393-4513
Practice Address - Street 1:3845 N DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-6468
Practice Address - Country:US
Practice Address - Phone:907-723-5775
Practice Address - Fax:505-393-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty