1871078808 NPI number — HEATHER ELIZABETH D'ERILEEN DNP

Table of content: HEATHER ELIZABETH D'ERILEEN DNP (NPI 1871078808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871078808 NPI number — HEATHER ELIZABETH D'ERILEEN DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'ERILEEN
Provider First Name:
HEATHER
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAMBERLAIN
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871078808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERLIN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97532-0081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-381-3685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 81
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERLIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97532-0081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-381-3685
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN60475412 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP60903132 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1871078808 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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