Provider Demographics
NPI:1346293537
Name:MALONEY, HEATHER L (CRNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:MALONEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 HIGHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2003
Mailing Address - Country:US
Mailing Address - Phone:205-612-6103
Mailing Address - Fax:
Practice Address - Street 1:1903 HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2003
Practice Address - Country:US
Practice Address - Phone:205-612-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121266163W00000X, 367500000X
TN11899367500000X
GARN208492367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL118698Medicaid
TN4118951OtherBCBS
AL102I436466Medicare UPIN
TN3636398Medicare ID - Type Unspecified