Provider Demographics
NPI:1275998452
Name:KURILLA, HEATHER LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYNN
Last Name:KURILLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2182
Mailing Address - Country:US
Mailing Address - Phone:518-338-3405
Mailing Address - Fax:518-338-3413
Practice Address - Street 1:310 DIXON RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2182
Practice Address - Country:US
Practice Address - Phone:518-338-3405
Practice Address - Fax:518-338-3413
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005383-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist