Provider Demographics
NPI:1932432036
Name:NEAVILL-PATTERSON, MARY JANE KNOX (LMT, HEALER)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:KNOX
Last Name:NEAVILL-PATTERSON
Suffix:
Gender:F
Credentials:LMT, HEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S COLONY WAY
Mailing Address - Street 2:# 10
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6900
Mailing Address - Country:US
Mailing Address - Phone:907-982-2112
Mailing Address - Fax:907-746-0033
Practice Address - Street 1:1150 S COLONY WAY
Practice Address - Street 2:# 10
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6900
Practice Address - Country:US
Practice Address - Phone:907-982-2112
Practice Address - Fax:907-746-0033
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK334616-00174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist