Provider Demographics
NPI:1649480864
Name:WADEHRA, HEATHER JEAN (RN, APN-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JEAN
Last Name:WADEHRA
Suffix:
Gender:F
Credentials:RN, APN-C
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN CPNP
Mailing Address - Street 1:621 BEVERLY RANCOCAS RD
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3727
Mailing Address - Country:US
Mailing Address - Phone:609-877-6800
Mailing Address - Fax:609-877-1570
Practice Address - Street 1:621 BEVERLY RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3727
Practice Address - Country:US
Practice Address - Phone:609-877-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN570491163W00000X
PASP009606363LP0200X
NJ26NJ00152200363LP0200X
NJ26NR12877800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification