Provider Demographics
NPI:1134232606
Name:CRUZ, HEATHER ANNE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:GALLATIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4022 LONG LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4062
Mailing Address - Country:US
Mailing Address - Phone:360-888-6793
Mailing Address - Fax:206-526-0219
Practice Address - Street 1:3626 NE 45TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5653
Practice Address - Country:US
Practice Address - Phone:206-526-2600
Practice Address - Fax:206-526-0219
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004207363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care