Healthcare Provider Details

I. General information

NPI: 1215811211
Provider Name (Legal Business Name): SYDNEY HENEGAN CPNP-AC/PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3300
  • Fax:
Mailing address:
  • Phone: 907-729-6351
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number240628
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number240628
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: