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NPI Code Detail

MEDICARE: MARIAN ELIZABETH HEESAKER N.P.

MEDICARE: MARIAN ELIZABETH HEESAKER N.P.
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
1363LF0000XFamily Nurse PractitionerAPN.0990391-NPCO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194083774
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAN ELIZABETH HEESAKER N.P.
Provider Business Mailing Address
First Line : 2754 COMPASS DR STE 377
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-8723
Country : US
Telephone Number : 970-255-7263
Fax Number : 970-255-7277
Provider Business Practice Location Address
First Line : 3090 N 12TH ST UNIT B
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-2804
Country : US
Telephone Number : 970-241-2212
Fax Number : 970-257-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2012
Last Update Date : 04/09/2019

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