Provider Demographics
NPI:1023796554
Name:HEATHERLY, CLAIRE KAREN
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:KAREN
Last Name:HEATHERLY
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 1:9543 N ARCHIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1484
Mailing Address - Country:US
Mailing Address - Phone:559-558-7631
Mailing Address - Fax:
Practice Address - Street 1:9543 N ARCHIE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1484
Practice Address - Country:US
Practice Address - Phone:559-558-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program