Provider Demographics
NPI:1568020188
Name:ANDERSON, HEIDI
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ANDERSON
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 1:402 SAINT NICHOLAS DR
Mailing Address - Street 2:
Mailing Address - City:DONORA
Mailing Address - State:PA
Mailing Address - Zip Code:15033-2196
Mailing Address - Country:US
Mailing Address - Phone:724-797-3161
Mailing Address - Fax:
Practice Address - Street 1:402 SAINT NICHOLAS DR
Practice Address - Street 2:
Practice Address - City:DONORA
Practice Address - State:PA
Practice Address - Zip Code:15033-2196
Practice Address - Country:US
Practice Address - Phone:724-797-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty