Provider Demographics
NPI:1477980480
Name:RYNKOWSKI, HEATHER MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:RYNKOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MICHELLE
Other - Last Name:REZNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:365 MONTAUK AVE
Mailing Address - Street 2:OFFICE # 3.525
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06357
Mailing Address - Country:US
Mailing Address - Phone:860-442-0711
Mailing Address - Fax:860-271-4988
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:OFFICE # 3.525
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06357
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:860-271-4988
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23.003003363A00000X, 363AS0400X
RI00729363AS0400X
CT3003363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant