Provider Demographics
NPI:1881881993
Name:HEATHER HARRISON, D.O., PLLC
Entity type:Organization
Organization Name:HEATHER HARRISON, D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-373-2001
Mailing Address - Street 1:1959 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1012
Mailing Address - Country:US
Mailing Address - Phone:801-373-2001
Mailing Address - Fax:801-373-4748
Practice Address - Street 1:1959 N STATE ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1012
Practice Address - Country:US
Practice Address - Phone:801-373-2001
Practice Address - Fax:801-373-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5960238-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty