Provider Demographics
NPI:1790506277
Name:HEISTER, KATHERINE LEIGH (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEIGH
Last Name:HEISTER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEIGH
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 JENNIFER LYNNE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21758-9030
Mailing Address - Country:US
Mailing Address - Phone:240-217-4774
Mailing Address - Fax:
Practice Address - Street 1:36 JENNIFER LYNNE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21758-9030
Practice Address - Country:US
Practice Address - Phone:240-217-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse