Healthcare Provider Details

I. General information

NPI: 1114028297
Provider Name (Legal Business Name): HEATHER MAYER HALLBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 HEALTHY WAY STE 330
VIRGINIA BEACH VA
23462-7958
US

IV. Provider business mailing address

828 HEALTHY WAY STE 330
VIRGINIA BEACH VA
23462-7958
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-3890
  • Fax: 757-467-0301
Mailing address:
  • Phone: 757-461-3890
  • Fax: 757-467-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024165870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: