Basic Information
| Provider Information | |||||||||
| NPI: | 1184066904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLERAN | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | PA-C, MSHS, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5054 W GERONIMO ST | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852264529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802056377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1626 S PRIEST DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852816204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808827320 | ||||||||
| FaxNumber: | 4809677920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2013 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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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 | 363A00000X | 5438 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.