Provider Demographics
NPI:1831265479
Name:HERON, UNKNOWN (RN)
Entity type:Individual
Prefix:MS
First Name:UNKNOWN
Middle Name:
Last Name:HERON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 N KISKA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7342
Mailing Address - Country:US
Mailing Address - Phone:503-285-4339
Mailing Address - Fax:
Practice Address - Street 1:3828 N KISKA CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-7342
Practice Address - Country:US
Practice Address - Phone:503-285-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health