Provider Demographics
NPI:1174836084
Name:MAI-ROECKER, HEATHER DANAE (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DANAE
Last Name:MAI-ROECKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DANAE
Other - Last Name:MAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7703 45TH PL W
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2711
Mailing Address - Country:US
Mailing Address - Phone:319-415-6573
Mailing Address - Fax:
Practice Address - Street 1:12800 BOTHELL EVERETT HWY STE 120
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6642
Practice Address - Country:US
Practice Address - Phone:425-316-5155
Practice Address - Fax:425-316-5156
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007340111N00000X
IAA135294363LF0000X
WAAP61165816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor