Provider Demographics
NPI:1740589902
Name:HAND, JACQUELINE SUZANNE (LMT, LE)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:HAND
Suffix:
Gender:F
Credentials:LMT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 LAKE OTIS PKWY
Mailing Address - Street 2:STE. 207
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5223
Mailing Address - Country:US
Mailing Address - Phone:907-563-2639
Mailing Address - Fax:907-563-2636
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:SUITE # 207
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-563-2639
Practice Address - Fax:907-563-2636
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMP1306172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKW176650292OtherAETNA