Healthcare Provider Details

I. General information

NPI: 1750123873
Provider Name (Legal Business Name): HEATHER KAY BIENZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 STATE ROUTE 31 STE 105
CICERO NY
13039-8715
US

IV. Provider business mailing address

PO BOX 100
ELBRIDGE NY
13060-0100
US

V. Phone/Fax

Practice location:
  • Phone: 315-752-3000
  • Fax: 315-685-0222
Mailing address:
  • Phone: 315-685-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: