Provider Demographics
NPI:1114028297
Name:HALLBERG, HEATHER MAYER (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAYER
Last Name:HALLBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HEALTHY WAY
Mailing Address - Street 2:STE 330
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7958
Mailing Address - Country:US
Mailing Address - Phone:757-461-3890
Mailing Address - Fax:757-467-0301
Practice Address - Street 1:828 HEALTHY WAY
Practice Address - Street 2:STE 330
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7958
Practice Address - Country:US
Practice Address - Phone:757-461-3890
Practice Address - Fax:757-467-0301
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165870363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024165870OtherLICENSE