Provider Demographics
NPI:1225518087
Name:SLYWKA, HEATHER ANNE (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:SLYWKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 STATE ROUTE 90
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-3179
Mailing Address - Country:US
Mailing Address - Phone:315-515-1148
Mailing Address - Fax:
Practice Address - Street 1:4099 STATE ROUTE 90
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13160-3179
Practice Address - Country:US
Practice Address - Phone:315-515-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649285163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health