Provider Demographics
NPI:1093737249
Name:GATESMAN, HEATHER CHRISTINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:GATESMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:CHRISTINE
Other - Last Name:SMARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:134 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2507
Mailing Address - Country:US
Mailing Address - Phone:203-755-3279
Mailing Address - Fax:203-755-3057
Practice Address - Street 1:134 GRANDVIEW AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2507
Practice Address - Country:US
Practice Address - Phone:203-755-3279
Practice Address - Fax:203-755-3057
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003467363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500002266Medicare UPIN
CT500002266Medicare PIN