Provider Demographics
NPI:1609644053
Name:KREUTTER, HEATHER A (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:KREUTTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2678
Mailing Address - Country:US
Mailing Address - Phone:201-360-7378
Mailing Address - Fax:
Practice Address - Street 1:15 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2678
Practice Address - Country:US
Practice Address - Phone:201-360-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005052171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist