Provider Demographics
NPI:1700084894
Name:HELLER, MARY ELIZABETH (RN,MS,CFNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HELLER
Suffix:
Gender:F
Credentials:RN,MS,CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-0134
Mailing Address - Country:US
Mailing Address - Phone:760-914-0439
Mailing Address - Fax:
Practice Address - Street 1:235 SIERRA PARK ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-0660
Practice Address - Country:US
Practice Address - Phone:760-934-2551
Practice Address - Fax:760-924-4081
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55715363LF0000X
CA428570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily