Provider Demographics
NPI:1063691194
Name:PORTEREIKO, HEATHER ANN (CRNA, APRN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN
Last Name:PORTEREIKO
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WHITMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 E RIVER DR
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3288
Mailing Address - Country:US
Mailing Address - Phone:860-282-4133
Mailing Address - Fax:860-289-0746
Practice Address - Street 1:99 E RIVER DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3288
Practice Address - Country:US
Practice Address - Phone:860-282-4133
Practice Address - Fax:860-289-0746
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT064908367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT430001409Medicare PIN