Healthcare Provider Details

I. General information

NPI: 1639586308
Provider Name (Legal Business Name): HEATHER RENEE MOZDY CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MYRTLE ST STE G30
ERIE PA
16502-4610
US

IV. Provider business mailing address

2315 MYRTLE ST STE G30
ERIE PA
16502-4610
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-5504
  • Fax: 814-452-5514
Mailing address:
  • Phone: 814-452-5504
  • Fax: 814-452-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW010349
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP018803
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11018680
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001864
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberSP018803
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: