Provider Demographics
NPI:1326554437
Name:HESTON, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:HARVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0346
Mailing Address - Country:US
Mailing Address - Phone:406-945-0393
Mailing Address - Fax:
Practice Address - Street 1:96 CLINIC RD N
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-8849
Practice Address - Country:US
Practice Address - Phone:406-395-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1249921164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0807119654120OtherDL