Healthcare Provider Details

I. General information

NPI: 1710107503
Provider Name (Legal Business Name): MRS. MARCY JEAN HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E 38TH ST
ERIE PA
16504-1559
US

IV. Provider business mailing address

2602 ACORN DR
LAKE CITY PA
16423-2610
US

V. Phone/Fax

Practice location:
  • Phone: 814-860-2109
  • Fax: 814-860-2488
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: