Healthcare Provider Details

I. General information

NPI: 1699706283
Provider Name (Legal Business Name): SHARON ANN HEIDECKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE STREET HAMOT FACULTY SPECIALISTS
ERIE PA
16550-0000
US

IV. Provider business mailing address

717 STATE ST SUITE 16, LL
ERIE PA
16501-1341
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6000
  • Fax:
Mailing address:
  • Phone: 814-480-7100
  • Fax: 814-480-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP006470B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: