Healthcare Provider Details

I. General information

NPI: 1275639353
Provider Name (Legal Business Name): CAROL HEBERT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST SUITE #105
ANCHORAGE AK
99508-5428
US

IV. Provider business mailing address

4001 DALE STREET SUITE #105
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-9930
  • Fax:
Mailing address:
  • Phone: 907-222-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number305
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: