Healthcare Provider Details

I. General information

NPI: 1417668559
Provider Name (Legal Business Name): CASSIE HEYLIGER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 FULTON AVE APT 2
HEMPSTEAD NY
11550-3935
US

IV. Provider business mailing address

316 FULTON AVE APT 2
HEMPSTEAD NY
11550-3935
US

V. Phone/Fax

Practice location:
  • Phone: 702-917-5402
  • Fax:
Mailing address:
  • Phone: 702-917-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number34254001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: