Provider Demographics
NPI:1366501652
Name:HEIDERSBERGER, MARYANN A (RNFA CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:A
Last Name:HEIDERSBERGER
Suffix:
Gender:F
Credentials:RNFA CRNFA
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:HEIDERSBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN BSN CNOR RNFA
Mailing Address - Street 1:PO BOX 970528
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33097
Mailing Address - Country:US
Mailing Address - Phone:954-227-8224
Mailing Address - Fax:954-227-7442
Practice Address - Street 1:1508 SW 5TH COURT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-646-1880
Practice Address - Fax:954-522-6222
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1168742163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant