Healthcare Provider Details

I. General information

NPI: 1134437049
Provider Name (Legal Business Name): MARY HEERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

34 MAPLE STREET SMILOW BREAST CARE CENTER - NORWALK HOSPITAL
NORWALK CT
06856
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2757
  • Fax: 203-855-3876
Mailing address:
  • Phone: 203-852-2757
  • Fax: 203-855-3876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4008
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number004008
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: