Individual
DR. DOMINIKA GRODZICKA HEUSINKVELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2458
(928) 283-2677
Mailing address
PO BOX 600, TUBA CITY, AZ 86045-0600
(928) 283-2458
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43843
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05686202
—
NM
05
—
09529730
—
CO
Enumeration date
11/02/2005
Last updated
02/17/2014
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