Provider Demographics
NPI:1790869097
Name:HEFFERNAN, NANCY J (NP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:415 W BENJAMIN HOLT DR
Practice Address - Street 2:D-4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3958
Practice Address - Country:US
Practice Address - Phone:209-472-7569
Practice Address - Fax:209-477-1065
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA658516163W00000X
CA19052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse