# HEATHER BROCK, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538359310
- **Authorized official:** MS. KATHLEEN GIANOTTI (BILLING MANAGER)
- **Authorized official phone:** (805) 550-6456

## Contact information

- **Practice address:** 851 E WESTPOINT DR STE 302, WASILLA, AK 99654-7183
- **Practice address phone:** (907) 373-5015
- **Practice address fax:** (907) 373-7015
- **Mailing address:** 2521 E MOUNTAIN VILLAGE STE B, PMB242, WASILLA, AK 99654-7374
- **Mailing address phone:** (907) 373-5015
- **Mailing address fax:** (907) 373-7015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 751 | AK | Yes |

## Other

- **Enumeration date:** 07/27/2007
- **Last updated:** 02/22/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | NP8919 | — | AK |