Provider Demographics
NPI:1780675314
Name:HEER, MARTHA K (CSA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:K
Last Name:HEER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5343
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-5343
Mailing Address - Country:US
Mailing Address - Phone:602-320-4428
Mailing Address - Fax:602-237-6463
Practice Address - Street 1:1501 W FRIER DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85312-5343
Practice Address - Country:US
Practice Address - Phone:602-320-4428
Practice Address - Fax:602-237-6463
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2521246ZC0007X
AZ363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant