Provider Demographics
NPI:1184735458
Name:HEROS, ELSA MARIE (CNM)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:MARIE
Last Name:HEROS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:H
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 1638
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1638
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:330 SABATTUS STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-777-4300
Practice Address - Fax:207-755-3021
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM82030163WR0006X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEQ05784Medicare UPIN