Provider Demographics
NPI:1275254419
Name:HEATON, MARGARET ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:HEATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:SAKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2402 ALVORD LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5102
Mailing Address - Country:US
Mailing Address - Phone:310-968-1330
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily