Healthcare Provider Details

I. General information

NPI: 1902459308
Provider Name (Legal Business Name): BRITTANY MARIE HEFFERNAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37923 W 12 MILE RD STE B
FARMINGTON HILLS MI
48331-3035
US

IV. Provider business mailing address

37923 W 12 MILE RD STE B
FARMINGTON HILLS MI
48331-3035
US

V. Phone/Fax

Practice location:
  • Phone: 248-987-4877
  • Fax:
Mailing address:
  • Phone: 248-987-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: