Provider Demographics
NPI:1487056602
Name:BARRETT-HEITZENRATER, AMY (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BARRETT-HEITZENRATER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1570
Mailing Address - Country:US
Mailing Address - Phone:814-838-2743
Mailing Address - Fax:814-835-1320
Practice Address - Street 1:5665 E LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1570
Practice Address - Country:US
Practice Address - Phone:814-838-2743
Practice Address - Fax:814-835-1320
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN276029164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse