Provider Demographics
NPI:1568108173
Name:CUMO, HEATHER (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CUMO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2128
Mailing Address - Country:US
Mailing Address - Phone:724-944-9313
Mailing Address - Fax:
Practice Address - Street 1:235 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:PA
Practice Address - Zip Code:16116-2115
Practice Address - Country:US
Practice Address - Phone:724-965-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN258140L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse