Provider Demographics
NPI:1306162789
Name:HEAVILIN, NANCY DAYZIE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:DAYZIE
Last Name:HEAVILIN
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:PO BOX 5579
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-5579
Mailing Address - Country:US
Mailing Address - Phone:541-548-2164
Mailing Address - Fax:541-548-0534
Practice Address - Street 1:211 NW LARCH AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1357
Practice Address - Country:US
Practice Address - Phone:541-548-2164
Practice Address - Fax:541-548-0534
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0052767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics