Provider Demographics
NPI:1407131113
Name:HANSSON, HEATHER MANTYLA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MANTYLA
Last Name:HANSSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:MANTYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3 SONORA DR
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4612
Mailing Address - Country:US
Mailing Address - Phone:508-641-2962
Mailing Address - Fax:
Practice Address - Street 1:3 SONORA DR
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4612
Practice Address - Country:US
Practice Address - Phone:508-641-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172006363LF0000X
MARN2263055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily