Provider Demographics
NPI:1023480449
Name:BANDLE, HEATHER ROSE (NP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROSE
Last Name:BANDLE
Suffix:
Gender:F
Credentials:NP-C
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 910876
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-0876
Mailing Address - Country:US
Mailing Address - Phone:435-268-2363
Mailing Address - Fax:435-215-2563
Practice Address - Street 1:2162 E 2800 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6235
Practice Address - Country:US
Practice Address - Phone:435-268-2363
Practice Address - Fax:435-215-2563
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-25
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7239980-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily