Healthcare Provider Details

I. General information

NPI: 1952968141
Provider Name (Legal Business Name): HEATHER ANNE MAHSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 COMMUNICATION DR
HANNIBAL MO
63401-3670
US

IV. Provider business mailing address

3920 OXFORD MNR
QUINCY IL
62305-8431
US

V. Phone/Fax

Practice location:
  • Phone: 573-603-1460
  • Fax: 573-603-1462
Mailing address:
  • Phone: 217-430-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019013311
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019018507
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: