Provider Demographics
NPI:1144476409
Name:DAIGLE-DAWSON, HEATHER M (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:DAIGLE-DAWSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:DAIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:743 SOUTH AVE
Mailing Address - Street 2:MARINA VILLAGE
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605
Mailing Address - Country:US
Mailing Address - Phone:203-330-6000
Mailing Address - Fax:
Practice Address - Street 1:361 BIRD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2804
Practice Address - Country:US
Practice Address - Phone:203-332-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT071726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT071726OtherSTATE LICENSE
CT004236130Medicaid