Provider Demographics
NPI:1871147306
Name:DUNFORD, HEATHER ROBSON (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROBSON
Last Name:DUNFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1399 W 900 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3153
Mailing Address - Country:US
Mailing Address - Phone:801-691-9654
Mailing Address - Fax:
Practice Address - Street 1:17025 SNOWMOBILE LN
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7044
Practice Address - Country:US
Practice Address - Phone:907-696-7466
Practice Address - Fax:907-726-0332
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13799363A00000X
UT11450297-1206363A00000X
NDPAC0901363A00000X
AK179504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant