Provider Demographics
NPI:1528152956
Name:EMERSON, HEATHER M (PMH NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:EMERSON
Suffix:
Gender:F
Credentials:PMH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CHADWICK STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-2221
Mailing Address - Fax:207-662-6783
Practice Address - Street 1:131 CHADWICK STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-2221
Practice Address - Fax:207-662-6783
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81774363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432002499Medicaid
Q59929Medicare UPIN
MENP563102Medicare PIN
ME432002499Medicaid
MENP5631Medicare PIN
MENP563103Medicare PIN
MEP00440080Medicare PIN