Provider Demographics
NPI:1053492587
Name:ERRIGO, ELLEN U (CNM)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:U
Last Name:ERRIGO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 E PALMER WASILLA HWY #1
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7277
Mailing Address - Country:US
Mailing Address - Phone:907-357-4963
Mailing Address - Fax:907-357-1894
Practice Address - Street 1:3223 PALMER WASILLA HWY
Practice Address - Street 2:SUITE #1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7236
Practice Address - Country:US
Practice Address - Phone:907-357-4963
Practice Address - Fax:907-357-1894
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK613367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP8764Medicaid
AK151448Medicare PIN
AKNP8764Medicaid
151448Medicare ID - Type Unspecified