Provider Demographics
NPI:1295057149
Name:HEISER, LINSLEY (MA)
Entity type:Individual
Prefix:
First Name:LINSLEY
Middle Name:
Last Name:HEISER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6920
Mailing Address - Country:US
Mailing Address - Phone:907-868-5138
Mailing Address - Fax:907-929-6005
Practice Address - Street 1:10220 LONE TREE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-6920
Practice Address - Country:US
Practice Address - Phone:907-868-5138
Practice Address - Fax:907-929-6005
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG730Medicaid