Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID67 | AK |
NPI | 1043526098 |
---|---|
Provider Name | Jennifer A Cave |
First Address | Wasilla, AK 99654-6734 |
Second Address | Wasilla, AK 99654-6734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2010 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1570639 | (05) | AK |