Provider Demographics
NPI:1023061181
Name:NASKER, HEATHER J (CRNA, MSN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:NASKER
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:J
Other - Last Name:STUMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, MSN
Mailing Address - Street 1:746 JARBIDGE AVE.
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-0000
Mailing Address - Country:US
Mailing Address - Phone:208-412-8177
Mailing Address - Fax:
Practice Address - Street 1:3235 N TOWERBRIDGE WAY
Practice Address - Street 2:#100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5721
Practice Address - Country:US
Practice Address - Phone:208-412-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20516.769367500000X
OR200560042CRNA367500000X
KY4788A367500000X
IDRNA-364367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273226Medicaid
WY312042OtherBLUE CROSS BLUE SHIELD
NE10024962200Medicaid
WY118252800Medicaid
ID807334300Medicaid
WY312042OtherBLUE CROSS BLUE SHIELD
ORS73999Medicare UPIN
WY430079635Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OR273226Medicaid