Provider Demographics
NPI:1396872032
Name:HART, HEIDI LOUISE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LOUISE
Last Name:HART
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 SW DELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4853
Mailing Address - Country:US
Mailing Address - Phone:503-646-9529
Mailing Address - Fax:
Practice Address - Street 1:15455 NW GREENBRIER PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7374
Practice Address - Country:US
Practice Address - Phone:503-533-9870
Practice Address - Fax:503-914-1590
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000032754N6 PMHNP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050182Medicaid