Provider Demographics
NPI:1033693031
Name:HECK, HEATHER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:HECK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CORNWAL ROAD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7480
Mailing Address - Country:US
Mailing Address - Phone:717-675-1780
Mailing Address - Fax:
Practice Address - Street 1:1701 CORNWAL ROAD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7480
Practice Address - Country:US
Practice Address - Phone:717-675-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$Medicaid