Healthcare Provider Details

I. General information

NPI: 1114001567
Provider Name (Legal Business Name): HEIDI WURZBURG RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY SUITE 110
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-4000
  • Fax:
Mailing address:
  • Phone: 707-571-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN411581 NP5666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: