Healthcare Provider Details

I. General information

NPI: 1932622024
Provider Name (Legal Business Name): HEATHER ROSE PRYOR NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 NYE RD
LYONS NY
14489-9106
US

IV. Provider business mailing address

1529 NYE RD
LYONS NY
14489-9106
US

V. Phone/Fax

Practice location:
  • Phone: 585-545-8931
  • Fax:
Mailing address:
  • Phone: 585-545-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341830-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: