Provider Demographics
NPI:1487193793
Name:HASTEROK, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HASTEROK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 LAKE OTIS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5235
Mailing Address - Country:US
Mailing Address - Phone:907-375-5200
Mailing Address - Fax:907-375-5203
Practice Address - Street 1:4015 LAKE OTIS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5235
Practice Address - Country:US
Practice Address - Phone:907-375-5200
Practice Address - Fax:907-375-5203
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARB090489363L00000X
AK209900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner