Provider Demographics
NPI:1508854647
Name:HEFFERNAN, CATHARINE ANNE (CNM)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:ANNE
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANNE
Other - Last Name:HEFFERNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM MSN
Mailing Address - Street 1:172 SHEEPSKIN BOG RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:ME
Mailing Address - Zip Code:04255-3634
Mailing Address - Country:US
Mailing Address - Phone:207-205-1268
Mailing Address - Fax:207-624-3845
Practice Address - Street 1:24 MILES CENTER WAY
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-563-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM82009367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5365632OtherNON HMO AETNA
ME3699646OtherHMO AETNA
ME510524452OtherMEDNET
ME047918OtherANTHEM BC/BS
ME251880099Medicaid
MAAA26161OtherHARVARD PILGRAM
ME047918OtherANTHEM MANAGED CARE
ME5892611OtherCIGNA
ME251880099Medicaid
ME5892611OtherCIGNA
MES94967Medicare UPIN