Healthcare Provider Details

I. General information

NPI: 1588896377
Provider Name (Legal Business Name): MARY JOAN HEFFERNAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE SUITE 180
BELLEVUE WA
98004-4623
US

IV. Provider business mailing address

1135 116TH AVE NE SUITE 180
BELLEVUE WA
98004-4623
US

V. Phone/Fax

Practice location:
  • Phone: 425-467-3785
  • Fax: 425-635-6656
Mailing address:
  • Phone: 425-467-3785
  • Fax: 425-635-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60097092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: