Provider Demographics
NPI:1609505114
Name:FOCKEN, HEATH (CHW)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:
Last Name:FOCKEN
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3747
Mailing Address - Country:US
Mailing Address - Phone:651-243-3907
Mailing Address - Fax:612-236-4745
Practice Address - Street 1:1919 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3747
Practice Address - Country:US
Practice Address - Phone:651-243-3907
Practice Address - Fax:612-236-4745
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker