Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 138031 | AK |
NPI | 1053874388 |
---|---|
Provider Name | Julia Koval |
First Address | Anchorage, AK 99507-1262 |
Second Address | Anchorage, AK 99508-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2019 |
Last Update Date | 12/04/2019 |