Provider Demographics
NPI:1740858455
Name:MANWARREN, HEATHER (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MANWARREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13411-0114
Mailing Address - Country:US
Mailing Address - Phone:607-373-6504
Mailing Address - Fax:
Practice Address - Street 1:6678 COUNTY ROAD 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3502
Practice Address - Country:US
Practice Address - Phone:607-335-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688776163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool