Provider Demographics
NPI:1467754333
Name:LOSEE, HEATHER (NP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:LOSEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACKSTONE STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-453-7520
Mailing Address - Fax:401-453-7529
Practice Address - Street 1:1 BLACKSTONE STREET, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-453-7520
Practice Address - Fax:401-453-7529
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256291363LA2200X
MARN256291363LG0600X
RIAPRN02549363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003076801OtherMEDICARE PTAN