Provider Demographics
NPI:1235794553
Name:DIFEDERICO, HEATHER ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:DIFEDERICO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:MCKANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1092
Mailing Address - Country:US
Mailing Address - Phone:315-781-0402
Mailing Address - Fax:315-828-1790
Practice Address - Street 1:101 CARTER RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1053
Practice Address - Country:US
Practice Address - Phone:315-781-0402
Practice Address - Fax:315-828-1790
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY643867163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool