Healthcare Provider Details

I. General information

NPI: 1720415086
Provider Name (Legal Business Name): HEATHER C MCTIGUE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER KOCHER

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 EMRICK BLVD STE 112
BETHLEHEM PA
18020-8037
US

IV. Provider business mailing address

3101 EMRICK BLVD STE 112
BETHLEHEM PA
18020-8037
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5570
  • Fax: 833-932-1227
Mailing address:
  • Phone: 484-822-5570
  • Fax: 833-932-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP013222
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: