Basic Information
| Provider Information | |||||||||
| NPI: | 1972735835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | L'HEUREUX | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 N PINE ST | ||||||||
| Address2: | |||||||||
| City: | BLUE HILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689305532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027568113 | ||||||||
| FaxNumber: | 4027562142 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 N PINE ST | ||||||||
| Address2: | |||||||||
| City: | BLUE HILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689305532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027562141 | ||||||||
| FaxNumber: | 4027562142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 08/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 111048 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 111048 | 01 | NE | APRN | OTHER |