MEDICARE: HEATHER HARRISON, D.O., PLLC

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	207Q00000X	Family Medicine Physician	5960238-1204	UT

General Provider Information

NPI Number	:	1881881993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER HARRISON, D.O., PLLC

Provider Business Mailing Address
First Line	:	1959 N STATE ST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-1012
Country	:	US
Telephone Number	:	801-373-2001
Fax Number	:	801-373-4748

Provider Business Practice Location Address
First Line	:	1959 N STATE ST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-1012
Country	:	US
Telephone Number	:	801-373-2001
Fax Number	:	801-373-4748

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	HEATHER R. HARRISON
Credential	:	D.O.
Telephone Number	:	801-373-2001

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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