Healthcare Provider Details

I. General information

NPI: 1457084816
Provider Name (Legal Business Name): HEATHER WAUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E MAIN ST
ENDICOTT NY
13760-5430
US

IV. Provider business mailing address

33 LEWIS RD FL 2
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-7171
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349809
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number604264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: