Healthcare Provider Details

I. General information

NPI: 1972142131
Provider Name (Legal Business Name): PATH OF THE HEART, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 01/04/2020
Certification Date: 01/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E CHICKALOON WAY
WASILLA AK
99654-3850
US

IV. Provider business mailing address

375 E CHICKALOON WAY
WASILLA AK
99654-3850
US

V. Phone/Fax

Practice location:
  • Phone: 907-355-2739
  • Fax:
Mailing address:
  • Phone: 907-355-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SS0200X
TaxonomySchool Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WENDY DEGRAFFENRIED
Title or Position: PRESIDENT
Credential: BSN, RN, NCSN
Phone: 907-355-2739