Provider Demographics
NPI:1740479922
Name:HEFFERNAN, DAWN MARIE (RN, NURSE ANESTHESIA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:RN, NURSE ANESTHESIA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NURSE PRACTITION
Mailing Address - Street 1:15 ARROWHEAD CIR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1747
Mailing Address - Country:US
Mailing Address - Phone:617-461-3605
Mailing Address - Fax:978-432-1791
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2714
Practice Address - Country:US
Practice Address - Phone:978-741-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230659163W00000X, 363LF0000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily