Provider Demographics
NPI:1235341488
Name:MACNAK, JUDITH ANN (RN, CHTP, CMT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:MACNAK
Suffix:
Gender:F
Credentials:RN, CHTP, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9238 EMILY WAY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8873
Mailing Address - Country:US
Mailing Address - Phone:907-789-0729
Mailing Address - Fax:
Practice Address - Street 1:3245 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7809
Practice Address - Country:US
Practice Address - Phone:907-463-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11637163W00000X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)