Healthcare Provider Details

I. General information

NPI: 1134138464
Provider Name (Legal Business Name): HEATHER L HEPPENSTALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30809 1ST AVE S
FEDERAL WAY WA
98003-4074
US

IV. Provider business mailing address

30809 1ST AVE S
FEDERAL WAY WA
98003-4074
US

V. Phone/Fax

Practice location:
  • Phone: 253-839-2030
  • Fax: 253-839-1071
Mailing address:
  • Phone: 253-839-2030
  • Fax: 253-839-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00020185
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: