Provider Demographics
NPI:1700120474
Name:SYGROVE, HEATHER LEIGH (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:SYGROVE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LEIGH
Other - Last Name:POLNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2108 E GELDING DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4620
Mailing Address - Country:US
Mailing Address - Phone:602-292-1202
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN161859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse