Provider Demographics
NPI:1881678597
Name:MILLIRON, HEATHER H (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:H
Last Name:MILLIRON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3709
Mailing Address - Country:US
Mailing Address - Phone:716-649-6687
Mailing Address - Fax:716-649-1502
Practice Address - Street 1:3969 LEGION DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3709
Practice Address - Country:US
Practice Address - Phone:716-649-6687
Practice Address - Fax:716-649-1502
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3001901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
R53934Medicare UPIN
NYB73591Medicare PIN