Provider Demographics
NPI:1467983882
Name:DALHAUG, HEIDI LYNETTE (NP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNETTE
Last Name:DALHAUG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7975 N HAYDEN RD
Mailing Address - Street 2:STE D354
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3243
Mailing Address - Country:US
Mailing Address - Phone:480-214-9720
Mailing Address - Fax:480-214-9722
Practice Address - Street 1:81 W GUADALUPE RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3321
Practice Address - Country:US
Practice Address - Phone:480-366-4490
Practice Address - Fax:480-854-3618
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN183693163W00000X
AZAP9872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ298888Medicaid