Provider Demographics
NPI:1639586308
Name:MOZDY, HEATHER RENEE (CNM, WHNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RENEE
Last Name:MOZDY
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST STE G30
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4610
Mailing Address - Country:US
Mailing Address - Phone:814-452-5504
Mailing Address - Fax:814-452-5514
Practice Address - Street 1:2315 MYRTLE ST STE G30
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4610
Practice Address - Country:US
Practice Address - Phone:814-452-5504
Practice Address - Fax:814-452-5514
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010349176B00000X
PASP018803363LW0102X, 367A00000X
FLAPRN11018680367A00000X
NY001864367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty