Provider Demographics
NPI:1437599420
Name:GULARTE, SHANNON (LAC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GULARTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13430 WINDRUSH CIR.
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516
Mailing Address - Country:US
Mailing Address - Phone:907-240-8418
Mailing Address - Fax:
Practice Address - Street 1:741 SESAME ST.
Practice Address - Street 2:STE. 1-B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK62171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist