Provider Demographics
NPI:1861656555
Name:HART, HEATHER DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:HART
Suffix:
Gender:F
Credentials:LMT
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 928
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-0928
Mailing Address - Country:US
Mailing Address - Phone:541-447-7950
Mailing Address - Fax:
Practice Address - Street 1:135 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1101
Practice Address - Country:US
Practice Address - Phone:541-447-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist