Provider Demographics
NPI:1225567787
Name:TUTAAN, SIERRA TALISE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:TALISE
Last Name:TUTAAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4011 ARCTIC BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5701
Mailing Address - Country:US
Mailing Address - Phone:907-561-7041
Mailing Address - Fax:907-561-2349
Practice Address - Street 1:4011 ARCTIC BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5701
Practice Address - Country:US
Practice Address - Phone:907-561-7041
Practice Address - Fax:907-561-2349
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist