Provider Demographics
NPI:1306384151
Name:HECKMAN, GWENDOLYN
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 5TH & TED STEVENS WAY
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0043
Mailing Address - Country:US
Mailing Address - Phone:907-442-7161
Mailing Address - Fax:907-442-7250
Practice Address - Street 1:5089 AIRPORT STREET
Practice Address - Street 2:
Practice Address - City:PILOT STATION
Practice Address - State:AK
Practice Address - Zip Code:99650
Practice Address - Country:US
Practice Address - Phone:907-549-3127
Practice Address - Fax:907-549-3738
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
AK15-1373-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker