Provider Demographics
NPI:1124504915
Name:DANGERFIELD, HEATHER MARIE (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:DANGERFIELD
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 W 8750 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9607
Mailing Address - Country:US
Mailing Address - Phone:801-541-0369
Mailing Address - Fax:
Practice Address - Street 1:1790 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2025
Practice Address - Country:US
Practice Address - Phone:801-224-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8311599-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health