Healthcare Provider Details

I. General information

NPI: 1265344170
Provider Name (Legal Business Name): MONIQUE PEDNAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 84TH AVE STE 204
ANCHORAGE AK
99507-3160
US

IV. Provider business mailing address

2610 BRYANT CIR APT C
ANCHORAGE AK
99507-3258
US

V. Phone/Fax

Practice location:
  • Phone: 907-444-1749
  • Fax:
Mailing address:
  • Phone: 907-444-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number102482
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: