Provider Demographics
NPI:1124857479
Name:MCCLURE, ALANA STICKNEY (LMT)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:STICKNEY
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LICHEN WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6491
Mailing Address - Country:US
Mailing Address - Phone:415-419-1073
Mailing Address - Fax:
Practice Address - Street 1:1118 2ND AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4228
Practice Address - Country:US
Practice Address - Phone:907-456-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty