Provider Demographics
NPI:1861603227
Name:MCKINNON, WENDY R (LMT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:MCKINNON
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 1:813 D ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3525
Mailing Address - Country:US
Mailing Address - Phone:907-276-5525
Mailing Address - Fax:907-276-5005
Practice Address - Street 1:813 D ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3525
Practice Address - Country:US
Practice Address - Phone:907-276-5525
Practice Address - Fax:907-276-5005
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1578627519OtherGROUP NPI
AK20-2172564OtherTAX ID