Provider Demographics
NPI:1356663876
Name:GOTTLIEB, HEIDEN (RN)
Entity Type:Individual
Prefix:
First Name:HEIDEN
Middle Name:
Last Name:GOTTLIEB
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 1:1218 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-7328
Mailing Address - Country:US
Mailing Address - Phone:541-482-9331
Mailing Address - Fax:
Practice Address - Street 1:1218 ROSE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-7328
Practice Address - Country:US
Practice Address - Phone:541-482-9331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841335RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health