Healthcare Provider Details

I. General information

NPI: 1811693328
Provider Name (Legal Business Name): WHITNEY BROOKE STATON L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BROOKE STATON L.M.T.

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W NORTHERN LIGHTS BLVD # C
ANCHORAGE AK
99503-3614
US

IV. Provider business mailing address

2225 ARCTIC BLVD APT 114
ANCHORAGE AK
99503-1931
US

V. Phone/Fax

Practice location:
  • Phone: 907-334-8020
  • Fax:
Mailing address:
  • Phone: 907-727-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number203989
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: