Basic Information
| Provider Information | |||||||||
| NPI: | 1649244252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEILESON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5342 SKYLINE DR | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014755503 | ||||||||
| FaxNumber: | 8014755503 | ||||||||
| Practice Location | |||||||||
| Address1: | MCKAY DEE HOSPITAL-EMERGENCY DEPARTMENT | ||||||||
| Address2: | 4401 HARRISON BLVD | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013877000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 41364 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 5124287-1205 | UT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34955861 | 05 | CO | MEDICAID |