Provider Demographics
NPI:1700939683
Name:EARLE, HEATHER R (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:EARLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1902 4TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2558
Mailing Address - Country:US
Mailing Address - Phone:541-663-0007
Mailing Address - Fax:541-663-0010
Practice Address - Street 1:1902 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2558
Practice Address - Country:US
Practice Address - Phone:541-663-0007
Practice Address - Fax:541-663-0010
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201900699NP-PP363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner