Provider Demographics
NPI:1134175631
Name:CARMICHAEL, HEATHER M (LAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:LUPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:104 KUTTER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3169
Mailing Address - Country:US
Mailing Address - Phone:907-452-3600
Mailing Address - Fax:907-452-3695
Practice Address - Street 1:104 KUTTER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3169
Practice Address - Country:US
Practice Address - Phone:907-452-3600
Practice Address - Fax:907-452-3695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK56171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist