Healthcare Provider Details

I. General information

NPI: 1740479922
Provider Name (Legal Business Name): DAWN MARIE HEFFERNAN RN, NURSE ANESTHESIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE MOORE RN, NURSE PRACTITION

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

15 ARROWHEAD CIR
ROWLEY MA
01969-1747
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-1200
  • Fax:
Mailing address:
  • Phone: 617-461-3605
  • Fax: 978-432-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230659
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230659
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number230659
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: