Provider Demographics
NPI:1013635689
Name:FORTSCH, HEATHER LEANN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANN
Last Name:FORTSCH
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 KELSO DR LOT 3
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1978
Mailing Address - Country:US
Mailing Address - Phone:814-746-8921
Mailing Address - Fax:
Practice Address - Street 1:1720 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1808
Practice Address - Country:US
Practice Address - Phone:814-453-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered