Individual
ANNELYSSA LEE MASSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
300 N MAIN ST, WASILLA, AK 99654-7017
(907) 376-8020
Mailing address
PO BOX 2843, PALMER, AK 99645-2843
(907) 414-8400
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
101662
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101662
STATE OF ALASKA, DEPARTMENT OF COMERCE
AK
Enumeration date
05/20/2016
Last updated
05/20/2016
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