Provider Demographics
NPI:1740377084
Name:SMITH, HEATHER M (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2004
Mailing Address - Country:US
Mailing Address - Phone:503-777-5995
Mailing Address - Fax:503-777-8005
Practice Address - Street 1:3202 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2004
Practice Address - Country:US
Practice Address - Phone:503-777-5995
Practice Address - Fax:503-777-8005
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550118NP363LF0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine