Provider Demographics
NPI:1437569548
Name:HASARA, HEATHER (CPNP-PC, IBCLC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HASARA
Suffix:
Gender:F
Credentials:CPNP-PC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12235 LITTLE BLUE HERON LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1689
Mailing Address - Country:US
Mailing Address - Phone:936-443-5287
Mailing Address - Fax:
Practice Address - Street 1:12235 LITTLE BLUE HERON LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1689
Practice Address - Country:US
Practice Address - Phone:936-443-5287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-50770163WL0100X
TX806376163WL0100X
TX1059420363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant