Active NPI
Annette Jo Heasman, RN
- School Registered Nurse
- Phoenix, AZ
National Provider Identifier
1215050562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Registered Nurse
- License
- RN017555
- Practice address
- 4636 N 40TH St
Phoenix, AZ 85018-3623 - Phone
- (602) 355-6668
- NPI assigned
- Apr 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | RN017555 | AZ | Primary |
Addresses
Primary practice location
4636 N 40TH St
Phoenix, AZ 85018-3623
Mailing address
4636 N 40TH St
Phoenix, AZ 85018-3623
Phone (602) 955-6668
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 568917 | Medicaid | AZ |
Other names 1
- Mrs. Annette Jo Heasman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN017555 | AZ | MD | School Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1215050562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4636 N 40TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850183623",
"telephone_number": "602-955-6668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4636 N 40TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850183623",
"telephone_number": "602-355-6668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEASMAN",
"first_name": "ANNETTE",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "163WS0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, School",
"state": "AZ",
"license": "RN017555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "568917",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ANNETTE",
"last_name": "HEASMAN",
"middle_name": "JO",
"prefix": "MRS.",
"credential": "RN",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.