Provider Demographics
NPI:1255651832
Name:GOELZ, HEATHER M
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:GOELZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 HOUSEL CRAFT RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44402-9603
Mailing Address - Country:US
Mailing Address - Phone:330-889-2168
Mailing Address - Fax:
Practice Address - Street 1:1098 HOUSEL CRAFT RD
Practice Address - Street 2:
Practice Address - City:BRISTOLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44402-9603
Practice Address - Country:US
Practice Address - Phone:330-889-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136751164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse