Provider Demographics
NPI:1477097335
Name:RACK, HEATHER LYNNE (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNE
Last Name:RACK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:COLVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:644 BRINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3938
Mailing Address - Country:US
Mailing Address - Phone:412-889-1985
Mailing Address - Fax:412-968-9182
Practice Address - Street 1:202 TIMBER RIDGE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2436
Practice Address - Country:US
Practice Address - Phone:724-580-8889
Practice Address - Fax:412-968-9182
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016474363L00000X
PARN589781163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse