Provider Demographics
NPI:1215777644
Name:WALZEL, HEATHER (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:WALZEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:POMFRET
Mailing Address - State:MD
Mailing Address - Zip Code:20675-3127
Mailing Address - Country:US
Mailing Address - Phone:301-646-6560
Mailing Address - Fax:
Practice Address - Street 1:4520 WOODLAND WAY
Practice Address - Street 2:
Practice Address - City:POMFRET
Practice Address - State:MD
Practice Address - Zip Code:20675-3127
Practice Address - Country:US
Practice Address - Phone:301-646-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1006296163W00000X
MDR168549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse