Provider Demographics
NPI:1154481554
Name:KORANDA, JOHANNA DOMITILIA (CDM)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:DOMITILIA
Last Name:KORANDA
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GLACIER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1845
Mailing Address - Country:US
Mailing Address - Phone:907-463-2600
Mailing Address - Fax:907-463-2675
Practice Address - Street 1:800 GLACIER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1845
Practice Address - Country:US
Practice Address - Phone:907-463-2600
Practice Address - Fax:907-463-2675
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK45176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife