Provider Demographics
NPI:1619215811
Name:BRUNER, HEIDI ANNE (LAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221442
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-1442
Mailing Address - Country:US
Mailing Address - Phone:907-229-5894
Mailing Address - Fax:
Practice Address - Street 1:16800 RANSOM RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-5352
Practice Address - Country:US
Practice Address - Phone:907-229-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK159171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1336457415OtherEMPLOYER: SNOW BLOSSOM ACUPUNCTURE'S EIN
AK47-1169902OtherEIN