Provider Demographics
NPI:1396101960
Name:KUPETZ, HEATHER (RN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KUPETZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19982 ENNIS DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-0990
Mailing Address - Country:US
Mailing Address - Phone:440-539-0490
Mailing Address - Fax:
Practice Address - Street 1:13883 DRAKE RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-7918
Practice Address - Country:US
Practice Address - Phone:440-268-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse