Provider Demographics
NPI:1417276411
Name:STOKES, HEATHER BRUCKER (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BRUCKER
Last Name:STOKES
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 1:286 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9780
Mailing Address - Country:US
Mailing Address - Phone:585-703-4096
Mailing Address - Fax:
Practice Address - Street 1:721 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2450
Practice Address - Country:US
Practice Address - Phone:585-703-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist