Provider Demographics
NPI:1972758522
Name:MAGGARD, STEPHANIE D (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:MAGGARD
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:PO BOX 10673
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99710-0673
Mailing Address - Country:US
Mailing Address - Phone:907-458-7423
Mailing Address - Fax:
Practice Address - Street 1:1222 WELL ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-2835
Practice Address - Country:US
Practice Address - Phone:907-458-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist