Provider Demographics
NPI:1780777813
Name:HERON, RITA K (NP, CNS)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:K
Last Name:HERON
Suffix:
Gender:F
Credentials:NP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1926
Mailing Address - Country:US
Mailing Address - Phone:978-376-0508
Mailing Address - Fax:
Practice Address - Street 1:4 UPLAND RD
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1926
Practice Address - Country:US
Practice Address - Phone:978-376-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141751363LP0808X, 364SP0809X
NH055656-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0860OtherBCBS
MANS0722Medicare ID - Type Unspecified