Provider Demographics
NPI:1144577834
Name:NOVOTNY, HEATHER ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:KUONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1336 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-2951
Practice Address - Country:US
Practice Address - Phone:607-734-3929
Practice Address - Fax:570-887-6820
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015840-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine