Provider Demographics
NPI:1285431817
Name:HEITZENRATER, JUSTINE HOPE
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:HOPE
Last Name:HEITZENRATER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:NY
Mailing Address - Zip Code:14012
Mailing Address - Country:US
Mailing Address - Phone:716-548-9777
Mailing Address - Fax:
Practice Address - Street 1:5904 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-886-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406753363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health