Provider Demographics
NPI:1366105389
Name:MINER-GOETZ, HEATHER LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:MINER-GOETZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SCHLENSKER DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-6087
Mailing Address - Country:US
Mailing Address - Phone:518-593-5127
Mailing Address - Fax:
Practice Address - Street 1:2 SCHLENSKER DR
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-6087
Practice Address - Country:US
Practice Address - Phone:518-593-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily