Provider Demographics
NPI:1134274129
Name:HEISEL, NANCY J (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:HEISEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 SW LURADEL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5780
Mailing Address - Country:US
Mailing Address - Phone:503-308-0654
Mailing Address - Fax:
Practice Address - Street 1:18010 SW MCEWAN RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7868
Practice Address - Country:US
Practice Address - Phone:503-525-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171272207R00000X
AK218217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine