Healthcare Provider Details

I. General information

NPI: 1104188093
Provider Name (Legal Business Name): HEATHER GITHENS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 COMPASSION CIR
ANCHORAGE AK
99504-1645
US

IV. Provider business mailing address

PO BOX 4105
PORTLAND OR
97208-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-9100
  • Fax: 907-212-9264
Mailing address:
  • Phone: 866-907-1068
  • Fax: 425-917-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR U 1300
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: