MEDICARE: HEATHER MAYER HALLBERG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	0024165870	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024165870	OTHER	VA	LICENSE

General Provider Information

NPI Number	:	1114028297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MAYER HALLBERG NP

Provider Business Mailing Address
First Line	:	828 HEALTHY WAY
Second Line	:	STE 330
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7958
Country	:	US
Telephone Number	:	757-461-3890
Fax Number	:	757-467-0301

Provider Business Practice Location Address
First Line	:	828 HEALTHY WAY
Second Line	:	STE 330
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7958
Country	:	US
Telephone Number	:	757-461-3890
Fax Number	:	757-467-0301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	05/10/2013

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