Provider Demographics
NPI:1609565035
Name:FRAVEL, HEATHER TERRICE (CNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:TERRICE
Last Name:FRAVEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:TERRICE
Other - Last Name:BOWDITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3057 CLOVERHURST ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2783
Mailing Address - Country:US
Mailing Address - Phone:330-933-7340
Mailing Address - Fax:
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.350456163WC0200X
OHAPRN.CNP.0034081363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1609565035Medicaid