Provider Demographics
NPI:1982892691
Name:PARRISH, JAN M (LICAC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LICAC
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 753
Mailing Address - Street 2:
Mailing Address - City:HOONAH
Mailing Address - State:AK
Mailing Address - Zip Code:99829-0753
Mailing Address - Country:US
Mailing Address - Phone:907-209-7547
Mailing Address - Fax:907-945-3721
Practice Address - Street 1:316 GARTEENI HWY
Practice Address - Street 2:
Practice Address - City:HOONAH
Practice Address - State:AK
Practice Address - Zip Code:99829
Practice Address - Country:US
Practice Address - Phone:907-209-7547
Practice Address - Fax:907-945-3721
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist