Provider Demographics
NPI:1780301549
Name:WINGERT, HEIDI LUISE
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LUISE
Last Name:WINGERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 WICKLOW CT
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9170
Mailing Address - Country:US
Mailing Address - Phone:717-798-0224
Mailing Address - Fax:
Practice Address - Street 1:117 HEALTH SCIENCES BUILDING 3640 COLONEL GLENN HIGHWAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45435-0001
Practice Address - Country:US
Practice Address - Phone:717-798-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program