Provider Demographics
NPI:1801984406
Name:HANEY, HEIDI SUE (FNP)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:SUE
Last Name:HANEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 POPLAR STREET
Mailing Address - Street 2:
Mailing Address - City:POWERS
Mailing Address - State:OR
Mailing Address - Zip Code:97466
Mailing Address - Country:US
Mailing Address - Phone:541-439-7884
Mailing Address - Fax:541-439-3225
Practice Address - Street 1:140 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:POWERS
Practice Address - State:OR
Practice Address - Zip Code:97466-0047
Practice Address - Country:US
Practice Address - Phone:541-439-7884
Practice Address - Fax:541-439-3225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ74903OtherUPIN