Provider Demographics
NPI:1770776619
Name:SOPER, HEATHER NICOLE (CNM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:SOPER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:39 BEAM LANE
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-213-7750
Mailing Address - Fax:540-213-7755
Practice Address - Street 1:39 BEAM LANE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-213-7750
Practice Address - Fax:540-213-7755
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0016991176B00000X
VA0024173624363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife