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General NPI Number Information
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NPI Number | 1154578490
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Entity Type | Organization
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Legal Business Name | HEATHER L. WOLLER, M.D., LLC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 3101 LATHROP ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-7426
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Country | US
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Telephone | 907-687-0672
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 84315
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City | FAIRBANKS
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State | AK
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Zip | 99708-4315
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Country | US
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Telephone | 907-687-0672
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEATHER L WOLLER
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Credential | MD
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Telephone | 907-687-0672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6149
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License Number State | AK
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