MEDICARE: MS. JUDITH HELLER APRN, FNP

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	363LA2200X	Adult Health Nurse Practitioner	000043	CT
2	363LP2300X	Primary Care Nurse Practitioner	0043	CT
3	363LF0000X	Family Nurse Practitioner	0043	CT

General Provider Information

NPI Number	:	1134191604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH HELLER APRN, FNP

Provider Business Mailing Address
First Line	:	67 MAPLE AVE
Second Line	:
City	:	DERBY
State	:	CT
Zip	:	06418-1328
Country	:	US
Telephone Number	:	203-732-1330
Fax Number	:	203-732-1332

Provider Business Practice Location Address
First Line	:	135 DIVISION STREET 1ST FLOOR
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2135
Country	:	US
Telephone Number	:	203-735-3500
Fax Number	:	203-735-0505

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/23/2021

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