Healthcare Provider Details

I. General information

NPI: 1184545790
Provider Name (Legal Business Name): AMY L HEFFERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 HIGH WATCH RD
EFFINGHAM NH
03882-8336
US

IV. Provider business mailing address

4388 WHITE MOUNTAIN HWY
SANBORNVILLE NH
03872-4075
US

V. Phone/Fax

Practice location:
  • Phone: 866-652-8889
  • Fax:
Mailing address:
  • Phone: 207-502-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: