Provider Demographics
NPI:1891991121
Name:BRISLEN, HEATHER C (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:C
Last Name:BRISLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4123 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1102
Mailing Address - Country:US
Mailing Address - Phone:505-433-7745
Mailing Address - Fax:505-265-5199
Practice Address - Street 1:4123 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-433-7745
Practice Address - Fax:505-265-5199
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2020-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine