Provider Demographics
NPI:1164753653
Name:HIPP, HEATHER LOHR (MSN-CRNA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LOHR
Last Name:HIPP
Suffix:
Gender:F
Credentials:MSN-CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:LOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-1003
Mailing Address - Country:US
Mailing Address - Phone:843-812-7305
Mailing Address - Fax:
Practice Address - Street 1:24 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1003
Practice Address - Country:US
Practice Address - Phone:843-812-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA 3929367500000X
SCAPRN 4104367500000X
GA188373367500000X
AZCRNA0697367500000X
RIAPRN02486367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ576975Medicaid