Provider Demographics
NPI:1366409765
Name:HEFFERNAN, MARGARET (NP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MONTE LARGO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1823
Mailing Address - Country:US
Mailing Address - Phone:505-508-4904
Mailing Address - Fax:505-508-4904
Practice Address - Street 1:1125 MONTE LARGO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1823
Practice Address - Country:US
Practice Address - Phone:505-508-4904
Practice Address - Fax:505-508-4904
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR66359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0073Medicare PIN
S19700Medicare UPIN