Provider Demographics
NPI:1134437049
Name:HEERY, MARY (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HEERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAPLE STREET
Mailing Address - Street 2:SMILOW BREAST CARE CENTER - NORWALK HOSPITAL
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06856
Mailing Address - Country:US
Mailing Address - Phone:203-852-2757
Mailing Address - Fax:203-855-3876
Practice Address - Street 1:34 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3815
Practice Address - Country:US
Practice Address - Phone:203-852-2757
Practice Address - Fax:203-855-3876
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004008364SX0200X
CT4008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004008OtherCT LICENSE NO.