Provider Demographics
NPI:1922466119
Name:GILLEY, MICHELLE (CPM, LM, CDM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GILLEY
Suffix:
Gender:F
Credentials:CPM, LM, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOSAIC MIDWIFERY, LLC, 4900 E PALMER-WASILLA HWY
Mailing Address - Street 2:STE 106 PMB 704
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5915
Mailing Address - Country:US
Mailing Address - Phone:405-532-4067
Mailing Address - Fax:907-231-7877
Practice Address - Street 1:6851 VAN GORDER DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623
Practice Address - Country:US
Practice Address - Phone:907-231-7877
Practice Address - Fax:907-231-7877
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMIDW0020176B00000X
AK214720176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife