Provider Demographics
NPI:1386692960
Name:TRAVIS, HEATHER S (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 DEFENSE HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-266-9694
Mailing Address - Fax:410-266-9695
Practice Address - Street 1:122 DEFENSE HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-9694
Practice Address - Fax:410-266-9695
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR131937163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD88427906OtherCAREFIRST MD
MDX697-0009OtherCAREFIRST DC
MD7285072OtherCIGNA
MD7285072OtherCIGNA