Provider Demographics
NPI:1194109033
Name:ELEPANO, HEATHER BAKER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BAKER
Last Name:ELEPANO
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 1:290 UNION BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2610
Mailing Address - Country:US
Mailing Address - Phone:973-595-0600
Mailing Address - Fax:
Practice Address - Street 1:290 UNION BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2610
Practice Address - Country:US
Practice Address - Phone:973-595-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13721400163WP0200X
NJ26NJ00547100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics