Provider Demographics
NPI:1639778681
Name:HEISEY, MEGAN SUSANNE (CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:SUSANNE
Last Name:HEISEY
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:SUSANNE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6924 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5256
Mailing Address - Country:US
Mailing Address - Phone:503-300-4111
Mailing Address - Fax:503-954-2122
Practice Address - Street 1:6924 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5256
Practice Address - Country:US
Practice Address - Phone:503-300-4111
Practice Address - Fax:503-954-2122
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027873363LP0222X
OR202201728NP-PP363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care