Provider Demographics
NPI:1245041276
Name:ABERCROMBIE, HEATHER JOLEANE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOLEANE
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22820 E APPLEWAY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5214
Mailing Address - Country:US
Mailing Address - Phone:509-473-4900
Mailing Address - Fax:
Practice Address - Street 1:22820 E APPLEWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5214
Practice Address - Country:US
Practice Address - Phone:509-473-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALPN61113269164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse