Healthcare Provider Details

I. General information

NPI: 1174553259
Provider Name (Legal Business Name): LAURA HEYING BOSTON MSN, CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA HEYING GOOLD CNM

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LANDIS AVE
CHULA VISTA CA
91910-2628
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2500
  • Fax:
Mailing address:
  • Phone: 619-515-2323
  • Fax: 619-906-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number376078
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5946
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMF792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: