Provider Demographics
NPI:1891749826
Name:SCHEIDEBERG, DONNA E (CNM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:SCHEIDEBERG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:E
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3223 E PALMER WASILLA HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7277
Mailing Address - Country:US
Mailing Address - Phone:907-375-4963
Mailing Address - Fax:907-357-1894
Practice Address - Street 1:3223 E PALMER WASILLA HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7277
Practice Address - Country:US
Practice Address - Phone:907-375-4963
Practice Address - Fax:907-357-1894
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1376367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17204Medicare ID - Type Unspecified
S58453Medicare UPIN