Provider Demographics
NPI:1801119219
Name:A WOMANS PLACE
Entity type:Organization
Organization Name:A WOMANS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:907-225-1231
Mailing Address - Street 1:355 CARLANNA LAKE RD
Mailing Address - Street 2:LOWER
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5614
Mailing Address - Country:US
Mailing Address - Phone:907-225-1231
Mailing Address - Fax:907-247-1231
Practice Address - Street 1:355 CARLANNA LAKE RD
Practice Address - Street 2:LOWER
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5614
Practice Address - Country:US
Practice Address - Phone:907-225-1231
Practice Address - Fax:907-247-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK940142367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty