=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437796497
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH MEGAN HEYER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2019
-----------------------------------------------------
Last Update Date | 06/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 ROWAN BLVD
-----------------------------------------------------
City | GLASSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08028-2260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-582-1500
-----------------------------------------------------
Fax | 856-218-9607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 545 HEREFORD LN
-----------------------------------------------------
City | MICKLETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08056-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-264-1547
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NR09783400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | SP021256
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------