Individual
AMANDA PENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDM
Contact information
Practice address
2054 30TH AVE, FAIRBANKS, AK 99701-7316
(907) 456-3719
Mailing address
2054 30TH AVE, FAIRBANKS, AK 99701-7316
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MIDM36
AK
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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