=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154948800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA MARIE HEIKEN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2020
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2946 E BANNER GATEWAY DR
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-624-8280
-----------------------------------------------------
Fax | 602-835-0192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2946 E BANNER GATEWAY DR
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-256-6444
-----------------------------------------------------
Fax | 480-256-3682
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 243390
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------