MEDICARE: MS. /ANDREA ROSE MARIE HEAVER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	208026-1	NY

General Provider Information

NPI Number	:	1114117827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. /ANDREA ROSE MARIE HEAVER LPN

Provider Business Mailing Address
First Line	:	44-I COTTAGE STREET
Second Line	:
City	:	PORTCHESTER
State	:	NY
Zip	:	10573-5147
Country	:	US
Telephone Number	:	914-761-1298
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 FERRIS AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-3446
Country	:	US
Telephone Number	:	914-761-1298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2007
Last Update Date	:	06/17/2014

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