Provider Demographics
NPI:1457338352
Name:MILLER HEERY, GRETCHEN H (NP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:H
Last Name:MILLER HEERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:HOPE
Other - Last Name:HEERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:154 SEMMELS HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9794
Mailing Address - Country:US
Mailing Address - Phone:570-386-9210
Mailing Address - Fax:
Practice Address - Street 1:56 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAINTOP
Practice Address - State:PA
Practice Address - Zip Code:18707
Practice Address - Country:US
Practice Address - Phone:570-474-6664
Practice Address - Fax:570-474-5536
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN335796L163W00000X
PASP007079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52403Medicare UPIN
055566Medicare ID - Type Unspecified