Provider Demographics
NPI:1467807263
Name:KLANER-WILSON, HEATHER (RN, CFRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KLANER-WILSON
Suffix:
Gender:F
Credentials:RN, CFRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1065
Mailing Address - Country:US
Mailing Address - Phone:724-562-9176
Mailing Address - Fax:
Practice Address - Street 1:705 N WEST ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1065
Practice Address - Country:US
Practice Address - Phone:724-562-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0048490163WE0003X
WV71127163WE0003X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WF0300XNursing Service ProvidersRegistered NurseFlight