Healthcare Provider Details

I. General information

NPI: 1851117402
Provider Name (Legal Business Name): LORIGENE IANU-MAILO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORIGENE IANU

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W 34TH AVE STE 218
ANCHORAGE AK
99503-3977
US

IV. Provider business mailing address

236 W 34TH AVE STE 218
ANCHORAGE AK
99503-3977
US

V. Phone/Fax

Practice location:
  • Phone: 907-290-5500
  • Fax: 907-302-5990
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number231537
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: