Provider Demographics
NPI:1316373335
Name:WILSON, HEATHER MARIE (LICENSED NURSE ASST)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LICENSED NURSE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 ISLINGTON ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4262
Mailing Address - Country:US
Mailing Address - Phone:603-431-0505
Mailing Address - Fax:603-431-2228
Practice Address - Street 1:1039 ISLINGTON ST
Practice Address - Street 2:SUITE 16
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4262
Practice Address - Country:US
Practice Address - Phone:603-431-0505
Practice Address - Fax:603-431-2228
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH029909-24376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide