Provider Demographics
NPI:1003217837
Name:PAVLIK, HEATHER (RDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PAVLIK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WALTER RD
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1329
Mailing Address - Country:US
Mailing Address - Phone:215-262-6547
Mailing Address - Fax:
Practice Address - Street 1:255 WALTER RD
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-1329
Practice Address - Country:US
Practice Address - Phone:215-262-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered