Provider Demographics
NPI:1114018934
Name:MAURO, HEATHER ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:MAURO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-507-3500
Mailing Address - Fax:801-507-3505
Practice Address - Street 1:5169 S COTTONWOOD ST STE 520
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6756
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:801-507-3505
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322893-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health