Provider Demographics
NPI:1760670004
Name:ANDRADE, HEATHER (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-992-6553
Mailing Address - Fax:508-990-7558
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:508-990-7558
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI414807OtherBLUE CHIP
MA0003515501OtherMEDICARE
MA1982607537OtherTRICARE
MA0715981Medicaid
MANP9388OtherBLUE CROSS BLUE SHIELD MA
MA0042867OtherNEIGHBORHOOD HEALTH
RI33402-2OtherBLUE CROSS BLUE SHIELD RI
MA0000000047342OtherBMCHEALTHNET