Healthcare Provider Details

I. General information

NPI: 1437796497
Provider Name (Legal Business Name): ELIZABETH MEGAN HEYER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 06/18/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROWAN BLVD
GLASSBORO NJ
08028-2260
US

IV. Provider business mailing address

545 HEREFORD LN
MICKLETON NJ
08056-1419
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-1500
  • Fax: 856-218-9607
Mailing address:
  • Phone: 856-264-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR09783400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberSP021256
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: