Provider Demographics
NPI:1881010163
Name:ROTH, HEATHER JANE (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JANE
Last Name:ROTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JANE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 ARCH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1473
Mailing Address - Country:US
Mailing Address - Phone:330-375-3211
Mailing Address - Fax:234-312-2457
Practice Address - Street 1:95 ARCH ST STE 300
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304
Practice Address - Country:US
Practice Address - Phone:330-375-3211
Practice Address - Fax:234-312-2457
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily