Healthcare Provider Details

I. General information

NPI: 1700013646
Provider Name (Legal Business Name): HEATHER BURKWHAT SPENGLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618TH DENTAL CO (AS) UNIT 15652 BOX 37
APO AP
96205-5652
US

IV. Provider business mailing address

618TH DENTAL CO (AS) UNIT 15652 BOX 37
APO AP
96205-5652
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-3101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number724521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: