Healthcare Provider Details

I. General information

NPI: 1154708980
Provider Name (Legal Business Name): HEATHER ZEZNOCK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 E MERIDIAN PARK LOOP STE 2
WASILLA AK
99654-7254
US

IV. Provider business mailing address

3122 E MERIDIAN PARK LOOP
WASILLA AK
99654-7255
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-2332
  • Fax: 907-357-9593
Mailing address:
  • Phone: 907-864-4625
  • Fax: 907-313-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number162734
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: