Provider Demographics
NPI:1154702009
Name:HELLER, GARY JOSEPH (RN)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:HELLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 COUNTRY SQUIRE ST NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9489
Mailing Address - Country:US
Mailing Address - Phone:330-417-9698
Mailing Address - Fax:
Practice Address - Street 1:2653 COUNTRY SQUIRE ST NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9489
Practice Address - Country:US
Practice Address - Phone:330-417-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN347037163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse