Healthcare Provider Details

I. General information

NPI: 1225859002
Provider Name (Legal Business Name): HEARTFELT PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SW DISK DR STE 250
BEND OR
97702-3754
US

IV. Provider business mailing address

1001 SW DISK DR STE 250
BEND OR
97702-3754
US

V. Phone/Fax

Practice location:
  • Phone: 541-859-3550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HOLLY MAUREEN MILLIGAN
Title or Position: OWNER/PEDIATRIC NURSE PRACTITIONER
Credential: CPNP-PC
Phone: 541-859-3550