Individual
MS. MARY MARGARET HEATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2515 CYCLONE DR STE B, WATERLOO, IA 50701
(319) 888-8044
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000927
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970016889
RR MDCR
IA
01
—
IA0106
JOHN DEERE HEALTHCARE
IA
Enumeration date
03/31/2006
Last updated
02/04/2022
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