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NPI Code Detail

MEDICARE: DELORIS CAROLYN BRICE

MEDICARE: DELORIS CAROLYN BRICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist212207AK

General Provider Information

NPI Number : 1558043364
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELORIS CAROLYN BRICE
Provider Business Mailing Address
First Line : 660 WILCOX AVE APT 15
Second Line :
City : FAIRBANKS
State : AK
Zip : 99709-3649
Country : US
Telephone Number : 907-371-7128
Fax Number :
Provider Business Practice Location Address
First Line : 1741 COLLEGE RD
Second Line :
City : FAIRBANKS
State : AK
Zip : 99709-4176
Country : US
Telephone Number : 907-456-4521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2023
Last Update Date : 08/01/2023

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Directions to “ DELORIS CAROLYN BRICE ” Practice Location

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