Healthcare Provider Details

I. General information

NPI: 1992751101
Provider Name (Legal Business Name): RACHEL LYNN HEANEY RN, APN, C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE TOMORROWS CHILDRENS INSTITUTE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

16 CEDAR RD
POMPTON PLAINS NJ
07444-1404
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5437
  • Fax: 201-457-1885
Mailing address:
  • Phone: 201-996-5437
  • Fax: 201-457-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNN098465
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: