Provider Demographics
NPI:1801183728
Name:A WOMAN'S PLACE LLC
Entity Type:Organization
Organization Name:A WOMAN'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-225-1231
Mailing Address - Street 1:PO BOX 8098
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-3098
Mailing Address - Country:US
Mailing Address - Phone:907-225-1231
Mailing Address - Fax:907-247-1231
Practice Address - Street 1:1601 TONGASS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6800
Practice Address - Country:US
Practice Address - Phone:907-225-1231
Practice Address - Fax:907-147-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK-524367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty