Provider Demographics
NPI:1609691765
Name:TENNEY, HEATHER MYRA
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MYRA
Last Name:TENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ROUTE 28 UNIT 11
Mailing Address - Street 2:
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-7300
Mailing Address - Country:US
Mailing Address - Phone:603-569-2838
Mailing Address - Fax:603-569-2838
Practice Address - Street 1:127 ROUTE 28 UNIT 11
Practice Address - Street 2:
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-7300
Practice Address - Country:US
Practice Address - Phone:603-569-2838
Practice Address - Fax:603-569-2838
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03557253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care