Provider Demographics
NPI:1427382456
Name:GRATTAN, HEIDEMARIE (ANP)
Entity type:Individual
Prefix:MS
First Name:HEIDEMARIE
Middle Name:
Last Name:GRATTAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:BAITING HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1344
Mailing Address - Country:US
Mailing Address - Phone:631-591-2159
Mailing Address - Fax:
Practice Address - Street 1:15 KIMBERLY COURT
Practice Address - Street 2:
Practice Address - City:BAITING HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:11946
Practice Address - Country:US
Practice Address - Phone:631-728-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304429-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health