Provider Demographics
NPI:1639130594
Name:MARTIN, HEATHER R (FNP, ANRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP, ANRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2440 E TUDOR RD
Mailing Address - Street 2:PMB 1168
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1185
Mailing Address - Country:US
Mailing Address - Phone:907-646-2559
Mailing Address - Fax:907-562-1319
Practice Address - Street 1:17101 SNOWMOBILE LN ST 102
Practice Address - Street 2:PRIMARY CARE ASSOCIATES
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-694-7223
Practice Address - Fax:907-696-5123
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP8888Medicaid
AK839OtherLICENSE
MM1359353OtherDEA
AKNP8888Medicaid
MM1359353OtherDEA