Healthcare Provider Details

I. General information

NPI: 1346876885
Provider Name (Legal Business Name): REBECCA GEM HEYWOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 PLAZA BLVD
PLATTSBURGH NY
12901-6438
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-536-7060
  • Fax: 518-536-7075
Mailing address:
  • Phone: 518-761-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: