Healthcare Provider Details

I. General information

NPI: 1134763428
Provider Name (Legal Business Name): HEATHER L ALDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 GOETHALS DR STE 200
RICHLAND WA
99352-3552
US

IV. Provider business mailing address

945 GOETHALS DR
RICHLAND WA
99352-3552
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2555
  • Fax: 509-942-2340
Mailing address:
  • Phone: 509-942-2555
  • Fax: 509-942-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP61011862
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: