Provider Demographics
NPI:1306155205
Name:LOKEN, AUTUMN PROMISE (CDM , RN)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:PROMISE
Last Name:LOKEN
Suffix:
Gender:F
Credentials:CDM , RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LYNNWOOD DR # C
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1850
Mailing Address - Country:US
Mailing Address - Phone:907-350-0778
Mailing Address - Fax:
Practice Address - Street 1:324 LYNNWOOD DR # C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1850
Practice Address - Country:US
Practice Address - Phone:907-350-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUR R 29189163W00000X
AKMID M 68176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse