Healthcare Provider Details

I. General information

NPI: 1003291881
Provider Name (Legal Business Name): ANNE HEUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 POCKET CT
NORTHPORT NY
11768-3018
US

IV. Provider business mailing address

10 POCKET CT
NORTHPORT NY
11768-3018
US

V. Phone/Fax

Practice location:
  • Phone: 631-766-1396
  • Fax:
Mailing address:
  • Phone: 631-766-1396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number425688-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: