=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407118367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER ANN CORTEZ RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2012
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 N MAIN ST
-----------------------------------------------------
City | FINDLAY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45840-3670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-525-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 MEADOWCREST CT
-----------------------------------------------------
City | MC COMB
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45858-9488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-788-0821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0807X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN.486800
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN.486800
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------