Provider Demographics
NPI:1972598589
Name:HEATHER, MARYANN NANETTE ANESI (MBCHB, BHB)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:NANETTE ANESI
Last Name:HEATHER
Suffix:
Gender:F
Credentials:MBCHB, BHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX LBJ GENERAL DELIVERY
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-1683
Mailing Address - Fax:
Practice Address - Street 1:1234 TURNDER DRIVE
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-1683
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS3066-C207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine