Provider Demographics
NPI:1326372764
Name:BERKEL, HEATHER MISSY (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MISSY
Last Name:BERKEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 W 3600 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-4715
Mailing Address - Country:US
Mailing Address - Phone:801-973-9675
Mailing Address - Fax:
Practice Address - Street 1:1906 W 3600 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-4715
Practice Address - Country:US
Practice Address - Phone:801-973-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3083662-4405363LF0000X, 363LF0000X
WY29215.1106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily