Provider Demographics
NPI:1255647343
Name:HOMPESCH, CORI ELIZABETH (CDM)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:ELIZABETH
Last Name:HOMPESCH
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 STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4658
Mailing Address - Country:US
Mailing Address - Phone:907-456-3719
Mailing Address - Fax:907-456-1511
Practice Address - Street 1:728 GAFFNEY RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4658
Practice Address - Country:US
Practice Address - Phone:907-456-3719
Practice Address - Fax:907-456-1511
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK66176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife