Provider Demographics
NPI:1376241752
Name:HARDING, HEATHER (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HARDING
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:ROCK TAVERN
Mailing Address - State:NY
Mailing Address - Zip Code:12575-5248
Mailing Address - Country:US
Mailing Address - Phone:845-467-0607
Mailing Address - Fax:
Practice Address - Street 1:30 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:ROCK TAVERN
Practice Address - State:NY
Practice Address - Zip Code:12575-5248
Practice Address - Country:US
Practice Address - Phone:845-467-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554452163WW0101X, 163WX0002X, 163WI0500X, 163WH0200X
NY554453163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH0200XNursing Service ProvidersRegistered NurseHome Health