Provider Demographics
NPI:1518537380
Name:BYWATERS-NORIEGA, HEIDY ANETT (QMHA)
Entity Type:Individual
Prefix:
First Name:HEIDY
Middle Name:ANETT
Last Name:BYWATERS-NORIEGA
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:HEIDY
Other - Middle Name:ANETT
Other - Last Name:NORIEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:5185 SW LOMBARD AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4864
Mailing Address - Country:US
Mailing Address - Phone:458-239-1469
Mailing Address - Fax:
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 11
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3035
Practice Address - Country:US
Practice Address - Phone:458-239-1469
Practice Address - Fax:503-641-8548
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator