| Doctor Name: | LAURA J HEITZ |
| NPI Number: | 1013090554 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 17189.0261 |
| Business Practice Address: | 2620 Commercial Way Suite 051 Rock Springs, WY - 829014755 |
| Business Phone Number: | 3073822080 |
| Business Fax Number: | 3073825099 |
| Mailing Address: | 2620 Commercial Way, Suite 051 ROCK SPRINGS |
| State: | WY |
| Postal Code: | 829014755 |
| Phone Number: | 3073822080 |
| Fax Number: | 3073825099 |
| NPI Enumeration Date: | 10/20/2006 |
| NPI Last Update Date: | 01/25/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 17189.0261 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |