Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 45 | AK |
NPI | 1154481554 |
---|---|
Provider Name | Ms. Johanna Domitilia Koranda |
First Address | Juneau, AK 99801-1845 |
Second Address | Juneau, AK 99801-1845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |