Organization
HEATHER BROCK, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN GIANOTTI (BILLING MANAGER)
(805) 550-6456
Entity
Organization
Contact information
Practice address
851 E WESTPOINT DR STE 302, WASILLA, AK 99654-7183
(907) 373-5015
(907) 373-7015
Mailing address
2521 E MOUNTAIN VILLAGE STE B, PMB242, WASILLA, AK 99654-7374
(907) 373-5015
(907) 373-7015
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
751
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP8919
—
AK
Enumeration date
07/27/2007
Last updated
02/22/2024
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