Provider Demographics
NPI:1952968141
Name:MAHSMAN, HEATHER ANNE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:MAHSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 OXFORD MNR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-8431
Mailing Address - Country:US
Mailing Address - Phone:217-430-3978
Mailing Address - Fax:
Practice Address - Street 1:141 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3670
Practice Address - Country:US
Practice Address - Phone:573-603-1460
Practice Address - Fax:573-603-1462
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019013311163W00000X
MO2019018507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse