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General NPI Number Information
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NPI Number | 1801233564
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Entity Type | Individual
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Provider Name | HEIDI WILES
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Gender | Female
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 3039 DAVIS RD
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City | FAIRBANKS
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State | AK
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Zip | 99709-5234
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Country | US
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Telephone | 907-452-3600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71886
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City | FAIRBANKS
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State | AK
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Zip | 99707-1886
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Country | US
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Telephone | 907-322-2159
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 990606
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License Number State | AK
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