Provider Demographics
NPI:1720227218
Name:DUFFY, REBECCA IRENE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:IRENE
Last Name:DUFFY
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 1:4011 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:907-980-1468
Mailing Address - Fax:
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:907-980-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist