Healthcare Provider Details

I. General information

NPI: 1780777813
Provider Name (Legal Business Name): RITA K HERON NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 UPLAND RD
NEWBURYPORT MA
01950-1926
US

IV. Provider business mailing address

4 UPLAND RD
NEWBURYPORT MA
01950-1926
US

V. Phone/Fax

Practice location:
  • Phone: 978-376-0508
  • Fax:
Mailing address:
  • Phone: 978-376-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number141751
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number055656-23-08
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number141751
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: