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General NPI Number Information
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NPI Number | 1467303032
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Entity Type | Individual
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Provider Name | HEATHER PROCTOR ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 1000 E MOUNTAIN BLVD
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City | WILKES BARRE
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State | PA
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Zip | 18711-0001
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Country | US
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Telephone | 570-808-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 SIVELY ST
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City | HANOVER TOWNSHIP
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State | PA
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Zip | 18706-3970
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Country | US
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Telephone | 570-262-2056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2000668844
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2000668844
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License Number State | PA
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