Provider Demographics
NPI:1588908347
Name:WALLICK, HEATHER MARIE (ANP-C)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:WALLICK
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E KING ST # 510
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1781
Mailing Address - Country:US
Mailing Address - Phone:301-266-0493
Mailing Address - Fax:844-587-1405
Practice Address - Street 1:18 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-2218
Practice Address - Country:US
Practice Address - Phone:301-266-0493
Practice Address - Fax:844-587-1405
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012547363LA2200X
FLAPRN11016256363LA2200X
MDR207551363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA0912084OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS