Provider Demographics
NPI:1285397968
Name:HEIDER, ELIZABETH MACKENZIE
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MACKENZIE
Last Name:HEIDER
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 1:1410 N QUINN ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2928
Mailing Address - Country:US
Mailing Address - Phone:703-424-1056
Mailing Address - Fax:
Practice Address - Street 1:1410 N QUINN ST APT 5
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2928
Practice Address - Country:US
Practice Address - Phone:703-424-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program