Individual
MRS. JEANETTE STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
984 N MERIDIAN PL STE A, WASILLA, AK 99654-7215
(907) 631-4029
(907) 631-4128
Mailing address
24712 TEAL LOOP, CHUGIAK, AK 99567-5114
(907) 351-7191
(907) 622-4001
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
101955
AK
225700000X
Massage Therapist
MA 00014238
WA
Other
Enumeration date
01/14/2009
Last updated
10/24/2018
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