Provider Demographics
NPI:1689827842
Name:ITO, HISAKO (NCTMB/MPL)
Entity Type:Individual
Prefix:
First Name:HISAKO
Middle Name:
Last Name:ITO
Suffix:
Gender:F
Credentials:NCTMB/MPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 COWLES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4381
Mailing Address - Country:US
Mailing Address - Phone:907-479-4263
Mailing Address - Fax:907-457-2163
Practice Address - Street 1:946 COWLES ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4381
Practice Address - Country:US
Practice Address - Phone:907-479-4263
Practice Address - Fax:907-457-2163
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2008-1002175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath