MEDICARE: NANCY CLARE HERIZA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	M.D.14304	OR

General Provider Information

NPI Number	:	1487752515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY CLARE HERIZA M.D.

Provider Business Mailing Address
First Line	:	2339 AUBURN AVE
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-3831
Country	:	US
Telephone Number	:	541-524-9490
Fax Number	:	541-524-9491

Provider Business Practice Location Address
First Line	:	2339 AUBURN AVE
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-3831
Country	:	US
Telephone Number	:	541-524-9490
Fax Number	:	541-524-9491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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