Provider Demographics
NPI:1588896377
Name:HEFFERNAN, MARY JOAN (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-467-3785
Mailing Address - Fax:425-635-6656
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 180
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-467-3785
Practice Address - Fax:425-635-6656
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60097092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner