Provider Demographics
NPI:1720141427
Name:EFAW, HEATHER M (BS NUTRITION)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:M
Last Name:EFAW
Suffix:
Gender:F
Credentials:BS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ZELIE DR
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-9707
Mailing Address - Country:US
Mailing Address - Phone:412-647-6218
Mailing Address - Fax:
Practice Address - Street 1:1 ZELIE DR
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-9707
Practice Address - Country:US
Practice Address - Phone:412-647-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133N00000X133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist