Healthcare Provider Details

I. General information

NPI: 1437878337
Provider Name (Legal Business Name): NINA MARIE HEUGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 PINE DR
STONY POINT NY
10980-2515
US

IV. Provider business mailing address

83 PINE DR
STONY POINT NY
10980-2515
US

V. Phone/Fax

Practice location:
  • Phone: 347-706-9545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number655532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: