Provider Demographics
NPI:1265109219
Name:YARYAN, HEATHER RENEE (RN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RENEE
Last Name:YARYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SUMMERSONG CT
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5447
Mailing Address - Country:US
Mailing Address - Phone:575-779-9708
Mailing Address - Fax:
Practice Address - Street 1:835 SUMMERSONG CT
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5447
Practice Address - Country:US
Practice Address - Phone:575-779-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-75615163W00000X
CA95034466163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse