Healthcare Provider Details

I. General information

NPI: 1457338352
Provider Name (Legal Business Name): GRETCHEN H MILLER HEERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN HOPE HEERY NP

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 ARAMINGO AVE STE 5C
PHILADELPHIA PA
19134-4607
US

IV. Provider business mailing address

PO BOX 746722
ATLANTA GA
30374-6722
US

V. Phone/Fax

Practice location:
  • Phone: 215-444-7472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP007079
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007079
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP251273
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN335796L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: