Provider Demographics
NPI:1649949777
Name:MA, HEEKYEONG (NP-C)
Entity type:Individual
Prefix:
First Name:HEEKYEONG
Middle Name:
Last Name:MA
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 1:18 MILLDAM RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5847
Mailing Address - Country:US
Mailing Address - Phone:781-715-5632
Mailing Address - Fax:
Practice Address - Street 1:31 PINE ST STE 204
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1680
Practice Address - Country:US
Practice Address - Phone:617-739-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner