Provider Demographics
NPI:1851509541
Name:RADER, HEATHER NICHOLE (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:RADER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 N MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-1441
Mailing Address - Country:US
Mailing Address - Phone:419-615-3097
Mailing Address - Fax:
Practice Address - Street 1:94 N MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-1441
Practice Address - Country:US
Practice Address - Phone:419-615-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN317458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse