Healthcare Provider Details

I. General information

NPI: 1366409765
Provider Name (Legal Business Name): MARGARET HEFFERNAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MONTE LARGO DR NE
ALBUQUERQUE NM
87123-1823
US

IV. Provider business mailing address

1125 MONTE LARGO DR NE
ALBUQUERQUE NM
87123-1823
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-4904
  • Fax: 505-508-4904
Mailing address:
  • Phone: 505-508-4904
  • Fax: 505-508-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR66359
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: