Provider Demographics
NPI:1063791937
Name:VANDERVELDT, HEATHER ELIZABETH (NP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:VANDERVELDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:JORGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 COMPASS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1464
Mailing Address - Country:US
Mailing Address - Phone:508-350-2300
Mailing Address - Fax:508-350-2309
Practice Address - Street 1:1 COMPASS WAY STE 200
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1464
Practice Address - Country:US
Practice Address - Phone:508-350-2300
Practice Address - Fax:508-350-2309
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA269139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00273401OtherMEDICARE