Provider Demographics
NPI:1518077411
Name:NUDO, HEATHER MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:NUDO
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Gender:F
Credentials:PA
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Mailing Address - Street 1:600 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4014
Mailing Address - Country:US
Mailing Address - Phone:925-838-4900
Mailing Address - Fax:925-838-4920
Practice Address - Street 1:110 TAMPICO
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2998
Practice Address - Country:US
Practice Address - Phone:925-838-4900
Practice Address - Fax:925-838-4920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-11-14
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Provider Licenses
StateLicense IDTaxonomies
CAPA18334207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18334OtherLICENSE NUMBER