Provider Demographics
NPI:1770242844
Name:KANNHEISER, HEATHER M
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:KANNHEISER
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 1:890 BENNETTS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2736
Mailing Address - Country:US
Mailing Address - Phone:732-367-7530
Mailing Address - Fax:
Practice Address - Street 1:890 BENNETTS MILLS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2736
Practice Address - Country:US
Practice Address - Phone:732-367-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01255900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily