Provider Demographics
NPI:1144727918
Name:RUCKEL, LORNA DARLENE (LMT)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:DARLENE
Last Name:RUCKEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7244
Mailing Address - Country:US
Mailing Address - Phone:907-743-3040
Mailing Address - Fax:
Practice Address - Street 1:240 E TUDOR RD STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7244
Practice Address - Country:US
Practice Address - Phone:907-743-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101843225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK920166990OtherBLUE CROSS