Provider Demographics
NPI:1114567385
Name:SMITH, HEATHER (FNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:LUOKKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 MATHER AVE
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-1032
Mailing Address - Country:US
Mailing Address - Phone:906-360-5225
Mailing Address - Fax:
Practice Address - Street 1:921 W SHARON AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1921
Practice Address - Country:US
Practice Address - Phone:906-483-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner