Provider Demographics
NPI:1366603979
Name:CHAN, ROXANNE S (LAC, RN)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:S
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3343 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4145
Mailing Address - Country:US
Mailing Address - Phone:907-336-6692
Mailing Address - Fax:907-336-6690
Practice Address - Street 1:3343 FAIRBANKS ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4145
Practice Address - Country:US
Practice Address - Phone:907-336-6692
Practice Address - Fax:907-336-6690
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK98171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist