Doctor Name: | MRS. HEIDI RAE GADDESS |
NPI Number: | 1023353208 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | SP012473 |
Business Practice Address: | 339 W Spring St Suite 102 Titusville, PA - 163541655 |
Business Phone Number: | 8148279675 |
Business Fax Number: | 8148270216 |
Mailing Address: | 339 W Spring St, Suite 102 TITUSVILLE |
State: | PA |
Postal Code: | 163541655 |
Phone Number: | 8148279675 |
Fax Number: | 8148270216 |
NPI Enumeration Date: | 11/29/2012 |
NPI Last Update Date: | 11/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP012473 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |