Healthcare Provider Details

I. General information

NPI: 1780675314
Provider Name (Legal Business Name): MARTHA K HEER CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W FRIER DR
GLENDALE AZ
85312-5343
US

IV. Provider business mailing address

PO BOX 5343
GLENDALE AZ
85312-5343
US

V. Phone/Fax

Practice location:
  • Phone: 602-320-4428
  • Fax: 602-237-6463
Mailing address:
  • Phone: 602-320-4428
  • Fax: 602-237-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number2521
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: