Provider Demographics
NPI:1487752515
Name:HERIZA, NANCY CLARE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CLARE
Last Name:HERIZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-3831
Mailing Address - Country:US
Mailing Address - Phone:541-524-9490
Mailing Address - Fax:541-524-9491
Practice Address - Street 1:2339 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3831
Practice Address - Country:US
Practice Address - Phone:541-524-9490
Practice Address - Fax:541-524-9491
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM.D.14304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice