Provider Demographics
NPI:1376796268
Name:MCINTOSH, HEATHER INGRID
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:INGRID
Last Name:MCINTOSH
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 1:25 MACDONOUGH ST
Mailing Address - Street 2:APARTMENT 10
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2329
Mailing Address - Country:US
Mailing Address - Phone:718-638-7583
Mailing Address - Fax:
Practice Address - Street 1:25 MACDONOUGH ST
Practice Address - Street 2:APARTMENT 10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2329
Practice Address - Country:US
Practice Address - Phone:718-638-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229016164W00000X
NY904093-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010556898Medicaid