Provider Demographics
NPI:1477820421
Name:BURNELL, HEATHER S (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:BURNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:S
Other - Last Name:LEE-BURNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 HUFFMAN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3568
Mailing Address - Country:US
Mailing Address - Phone:907-345-2050
Mailing Address - Fax:907-345-9807
Practice Address - Street 1:3710 WOODLAND DR STE 1100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2589
Practice Address - Country:US
Practice Address - Phone:907-248-1122
Practice Address - Fax:907-248-4168
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant