Provider Demographics
NPI:1811232366
Name:GAST, HEIDI M (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:GAST
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1031 PIERCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5541
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BUILDING G
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-609-7506
Practice Address - Fax:419-609-1826
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.13663-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.245466-COA1OtherREGISTERED NURSE-1 CERTIFICATE OF AUTHORITY
OHCOA.13663-NPOtherCERTIFIED NURSE PRACTITIONER