Provider Demographics
NPI:1811396625
Name:MERRILL PROCTOR, HEATHER MARIE (PNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:MERRILL PROCTOR
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:325 MASON RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4611
Mailing Address - Country:US
Mailing Address - Phone:603-801-8393
Mailing Address - Fax:
Practice Address - Street 1:444 NASHUA ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4915
Practice Address - Country:US
Practice Address - Phone:603-673-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07278523363LP0200X
MARN2284575163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics