Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 191 | AK |
NPI | 1124015649 |
---|---|
Provider Name | Mary Ross |
First Address | Anchorage, AK 99508 |
Second Address | Anchorage, AK 99508-5213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 01/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NM0191 | (05) | AK |
NP0174 | (05) | AK |
NP01741 | (05) | AK |
S10650 | (02) | AK |