Individual
MISS GLENNA SUZANNE TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
291 E SWANSON AVE, WASILLA, AK 99654-7004
(907) 376-3275
Mailing address
PO BOX 873251, WASILLA, AK 99687-3251
(907) 434-1331
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/11/2024
Last updated
03/11/2024
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