MS. MARY MARGARET HEATLEY (NPI# 1134180870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134180870 |
| Entity Type | Individual |
| Full Name | MS. MARY MARGARET HEATLEY |
| Credential | PA-C |
| Practice Address |
2515 Cyclone Dr Ste B Waterloo IA 50701 |
| Mailing Address |
Po Box 2758 Waterloo IA 50704-2758 |
| Practice Telephone | 3198888044 |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-11-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 000927 | IA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | RR MDCR | 970016889 | 01 |
| IA | JOHN DEERE HEALTHCARE | IA0106 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1753 W Ridgeway Ave, Suite 110, Waterloo, IA 507014544 | 3198335970 | 3198335971 |
| Street Address |
2515 CYCLONE DR STE B |
| City | WATERLOO |
| State | IA |
| Zip Code | 50701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053971192 | Sieon Kim | Audiologist | 2515 Cyclone Dr Ste B, Waterloo, IA 50701-9746 | 2019-06-20 |
| 1720487838 | Crystal Wilken | Nurse Practitioner | 2515 Cyclone Dr Ste B, Waterloo, IA 50701 | 2014-08-14 |
| 1578651329 | Deborah Sue Rieks | Audiologist | 2515 Cyclone Dr Ste B, Waterloo, IA 50701-9746 | 2006-10-10 |
| 1639123243 | David James Congdon | Otolaryngology | 2515 Cyclone Dr Ste B, Waterloo, IA 50701-9746 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548757586 | Shawna Harvey | Optometrist | 999 Home Plz Ste 100, Waterloo, IA 50701 | 2018-04-16 |
| 1831693290 | Blue Gregory Boyer | Counselor | 3362 University Ave., Waterloo, IA 50701 | 2018-03-21 |
| 1518460666 | Tom Taylor | Specialist | 974 Home Plaza, Waterloo, IA 50701 | 2018-03-15 |
| 1194247551 | Homelink Sanford | Durable Medical Equipment & Medical Supplies | 1111 W San Marnan Drive, Waterloo, IA 50701 | 2017-07-07 |
| 1932471109 | Walgreens | Pharmacy | 111 W Ridgeway Avenue, Waterloo, IA 50701 | 2012-02-03 |
| 1598055188 | Knox Eyecare | Optometrist | 1030 Alabar Ave., Waterloo, IA 50701 | 2011-04-15 |
| 1013222330 | Ashley Lynn Charmichael | Dentist | 220 W. Ridgeway Ave., Suite 201, Waterloo, IA 50701 | 2010-08-11 |
| 1396062311 | Gwendoline Fang | Obstetrics & Gynecology | 1015 S. Hackett Road Suite 200, Department of Ob/gyn, Waterloo, IA 50701 | 2010-04-29 |
| 1013234194 | Ryan Norman Borgwardt | Dentist | 820 Fisher Drive, Waterloo, IA 50701 | 2010-04-28 |
| 1629302310 | Rhonda Kay Herum | Social Worker | 3731 Pheasant Lane #203, Waterloo, IA 50701 | 2009-09-28 |
| Find all providers in zip 50701 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013979079 | Shanon Dione Bennett | Physician Assistant | 1731 W Ridgeway Ave Ste 100, Waterloo, IA 50701-4591 | 2006-04-05 |
| 1306829775 | Jessica M Wachtel | Physician Assistant | 509 Hamacher Street, Suite 102, Waterloo, IL 62298 | 2005-11-21 |
| 1902893779 | Michelle B Nepple | Physician Assistant | 1717 W Ridgeway Ave, Waterloo, IA 50701 | 2005-10-05 |
| 1164421954 | Heidi M Bonthuis | Physician Assistant | 905 Franklin St, Waterloo, IA 50703-4407 | 2005-07-14 |
| 1003420100 | Paige Stanzel | Physician Assistant | 610 Jefferson St, Waterloo, NE 68069-2212 | 2020-09-04 |
| 1871120147 | Carolyn Anna Steenhoek | Physician Assistant | 1825 Logan Ave, Waterloo, IA 50703-1916 | 2020-03-25 |
| 1346784675 | Associated Physicians Group Ltd | Physician Assistant | 509 Hamacher St, Suite 202, Waterloo, IL 62298-1592 | 2016-12-06 |
| 1760774749 | Lynn Renee Day | Physician Assistant | 220 Southbrooke Dr, Waterloo, IA 50702-5802 | 2011-05-09 |
| 1578791570 | Andrea Leigh Hansen | Physician Assistant | 1825 Logan Ave, Emergency Department, Waterloo, IA 50703-1916 | 2009-06-29 |
| 1841434313 | Rebecca L. Chittenden | Physician Assistant | 1753 W Ridgeway Ave, Suite 102, Waterloo, IA 50701-4544 | 2009-04-28 |
| Find all providers in WATERLOO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.