Provider Demographics
NPI:1538830237
Name:MARIEKE HEATWOLE, LLC
Entity type:Organization
Organization Name:MARIEKE HEATWOLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ELSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-677-2990
Mailing Address - Street 1:205 E. DIMOND BLVD
Mailing Address - Street 2:PMB553
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-677-5910
Mailing Address - Fax:907-600-7711
Practice Address - Street 1:4101 ARCTIC BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5702
Practice Address - Country:US
Practice Address - Phone:907-677-5910
Practice Address - Fax:907-600-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty