1386814192 NPI number — JUNIPER MACFARLANE MSPT, CDT

Table of content: JUNIPER MACFARLANE MSPT, CDT (NPI 1386814192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386814192 NPI number — JUNIPER MACFARLANE MSPT, CDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACFARLANE
Provider First Name:
JUNIPER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT, CDT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386814192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 LAKE OTIS PKWY
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99507-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-770-6693
Provider Business Mailing Address Fax Number:
907-770-6697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 LAKE OTIS PKWY
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99507-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-770-6693
Provider Business Practice Location Address Fax Number:
907-770-6697
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  AK1220 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT47031 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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