Provider Demographics
NPI:1962471623
Name:HEIERTZ, JANE ELIZABETH (RN CPNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:HEIERTZ
Suffix:
Gender:F
Credentials:RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 OLD BRIDGE RD
Mailing Address - Street 2:STE 101 ALL PEDIATRICS
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2383
Mailing Address - Country:US
Mailing Address - Phone:703-491-9946
Mailing Address - Fax:703-491-4410
Practice Address - Street 1:1990 OLD BRIDGE RD
Practice Address - Street 2:STE 101 ALL PEDIATRICS
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2383
Practice Address - Country:US
Practice Address - Phone:703-491-9946
Practice Address - Fax:703-491-4410
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPNP0024164034363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics