Healthcare Provider Details

I. General information

NPI: 1700383320
Provider Name (Legal Business Name): HEATHER DUFOUR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 HOSPITAL DR LOWR LEVEL
EVERETT PA
15537-7020
US

IV. Provider business mailing address

11279 PERRY HWY STE 450
WEXFORD PA
15090-9303
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-9039
  • Fax: 814-623-0355
Mailing address:
  • Phone: 724-933-1100
  • Fax: 724-933-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018447
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: