Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN2282748 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2282748 | MA |
NPI | 1033458203 |
---|---|
Provider Name | Ms. Maria Jones Heidenreich |
First Address | Orange, MA 01364-1435 |
Second Address | Orange, MA 01364-1435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2013 |
Last Update Date | 08/02/2013 |