Healthcare Provider Details

I. General information

NPI: 1225957822
Provider Name (Legal Business Name): HAYLEE CORDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N MAIN ST
WASILLA AK
99654-7018
US

IV. Provider business mailing address

PO BOX 879746
WASILLA AK
99687-9746
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-8020
  • Fax:
Mailing address:
  • Phone: 907-521-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number255505
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: