Provider Demographics
NPI:1386855591
Name:FAIRALL, HEATHER ANN (LAC, MSAOM, EAMP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:FAIRALL
Suffix:
Gender:F
Credentials:LAC, MSAOM, EAMP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:FALKENBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MSAOM, EAMP
Mailing Address - Street 1:PO BOX 29792
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-1792
Mailing Address - Country:US
Mailing Address - Phone:360-305-9224
Mailing Address - Fax:855-230-4971
Practice Address - Street 1:5683 2ND AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8611
Practice Address - Country:US
Practice Address - Phone:360-305-9224
Practice Address - Fax:855-230-4971
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002986171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist