Healthcare Provider Details

I. General information

NPI: 1184066904
Provider Name (Legal Business Name): HEATHER HOLLERAN PA-C, MSHS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 S PRIEST DR SUITE 104
TEMPE AZ
85281-6204
US

IV. Provider business mailing address

5054 W GERONIMO ST
CHANDLER AZ
85226-4529
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7320
  • Fax: 480-967-7920
Mailing address:
  • Phone: 480-205-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5438
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: