Provider Demographics
NPI:1952511842
Name:SUGARMAN, HEATHER ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6835
Mailing Address - Country:US
Mailing Address - Phone:412-457-0175
Mailing Address - Fax:412-457-0179
Practice Address - Street 1:149 N VINE ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5852
Practice Address - Country:US
Practice Address - Phone:570-454-0500
Practice Address - Fax:570-454-5005
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA127733WFTMedicare PIN