Healthcare Provider Details

I. General information

NPI: 1730632951
Provider Name (Legal Business Name): HEATHER R NANNERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER R NANNERY NP

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 08/17/2023
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HAWLEY STREET
BINGHAMTON NY
13901
US

IV. Provider business mailing address

37 DIETZ STREET
ONEONTA NY
13820
US

V. Phone/Fax

Practice location:
  • Phone: 607-723-8306
  • Fax: 607-785-9862
Mailing address:
  • Phone: 607-432-2252
  • Fax: 607-432-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340868-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: