Provider Demographics
NPI:1255448668
Name:HEFTA, CHERYL A (NP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:HEFTA
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:4507 HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-8518
Mailing Address - Country:US
Mailing Address - Phone:701-662-2414
Mailing Address - Fax:701-766-1260
Practice Address - Street 1:416 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335
Practice Address - Country:US
Practice Address - Phone:701-766-1251
Practice Address - Fax:701-766-1260
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDR19042363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26450OtherBLUE CROSS/BLUE SHIELD