Provider Demographics
NPI:1003314766
Name:FRIEND, HEATHER MARIE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:FRIEND
Suffix:
Gender:F
Credentials:
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 22
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-0022
Mailing Address - Country:US
Mailing Address - Phone:458-244-8090
Mailing Address - Fax:458-244-8089
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9416
Practice Address - Country:US
Practice Address - Phone:458-244-8090
Practice Address - Fax:458-244-8089
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200541213RN163W00000X
OR201803718NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse