Provider Demographics
NPI:1972931418
Name:TOOTHMAN, HEATHER D (CRNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:TOOTHMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RAYMALEY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1450
Mailing Address - Country:US
Mailing Address - Phone:724-972-8679
Mailing Address - Fax:
Practice Address - Street 1:4 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-9129
Practice Address - Country:US
Practice Address - Phone:724-972-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily