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General NPI Number Information
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NPI Number | 1801228788
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Entity Type | Individual
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Provider Name | HEIDE PROVENCHER APRN
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Gender | Female
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | PO BOX 174
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City | HOPE
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State | AK
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Zip | 99605-0174
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Country | US
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Telephone | 907-227-6610
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Fax |
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Provider Business Mailing Address
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Address Line | 2437 INGRA ST
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City | ANCHORAGE
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State | AK
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Zip | 99508-3945
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Country | US
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Telephone | 907-227-6610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1343
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1343
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License Number State | AK
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