Healthcare Provider Details

I. General information

NPI: 1770610925
Provider Name (Legal Business Name): JAYNE SONTAG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47010 TOBACCO LANE
SOLDOTNA AK
99669
US

IV. Provider business mailing address

PO BOX 1373
SOLDOTNA AK
99669-1373
US

V. Phone/Fax

Practice location:
  • Phone: 907-748-5895
  • Fax: 907-262-6411
Mailing address:
  • Phone: 907-748-5895
  • Fax: 907-262-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number31
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: