Provider Demographics
NPI:1366654089
Name:HIAM, DEIRDRE R (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:R
Last Name:HIAM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:M
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1 LAMPLIGHTER WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT HERMON
Mailing Address - State:MA
Mailing Address - Zip Code:01354-9637
Mailing Address - Country:US
Mailing Address - Phone:413-498-3407
Mailing Address - Fax:413-498-3147
Practice Address - Street 1:1 LAMPLIGHTER WAY
Practice Address - Street 2:
Practice Address - City:MOUNT HERMON
Practice Address - State:MA
Practice Address - Zip Code:01354-9637
Practice Address - Country:US
Practice Address - Phone:413-498-3407
Practice Address - Fax:413-498-3147
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228669363LA2200X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA228669OtherCONNECTICARE
MA0713457Medicaid
MA126842OtherFALLON
MANP9544OtherBCBSMA
MA228669OtherCONNECTICARE