Provider Demographics
NPI:1770689978
Name:HEYSLER, REBECCA A (MSNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HEYSLER
Suffix:
Gender:F
Credentials:MSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12307-1508
Mailing Address - Country:US
Mailing Address - Phone:518-374-5353
Mailing Address - Fax:518-347-1413
Practice Address - Street 1:603 SENECA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421
Practice Address - Country:US
Practice Address - Phone:315-363-3950
Practice Address - Fax:315-363-3951
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3000021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226273Medicaid
NY01226273Medicaid