Healthcare Provider Details

I. General information

NPI: 1548540198
Provider Name (Legal Business Name): ANN JACQUELINE HEYWOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MARGARET ST SUITE 100
PLATTSBURGH NY
12901-1893
US

IV. Provider business mailing address

PO BOX 2868
PLATTSBURGH NY
12901-0259
US

V. Phone/Fax

Practice location:
  • Phone: 518-314-3939
  • Fax: 518-314-3940
Mailing address:
  • Phone: 518-562-7900
  • Fax: 518-562-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305808-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: