MEDICARE: HEATHER SPIEGEL AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	85848	OK

General Provider Information

NPI Number	:	1356862338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SPIEGEL AGACNP-BC

Provider Business Mailing Address
First Line	:	916 ETHAN LN
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-7155
Country	:	US
Telephone Number	:	580-583-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 NW 56TH ST STE 711
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4414
Country	:	US
Telephone Number	:	405-945-4562
Fax Number	:

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

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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