Provider Demographics
NPI:1154708980
Name:ZEZNOCK, HEATHER (DO)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:ZEZNOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7255
Mailing Address - Country:US
Mailing Address - Phone:907-864-4625
Mailing Address - Fax:907-313-1540
Practice Address - Street 1:3066 E MERIDIAN PARK LOOP STE 2
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7254
Practice Address - Country:US
Practice Address - Phone:907-357-2332
Practice Address - Fax:907-357-9593
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK162734208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program