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General NPI Number Information
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NPI Number | 1740628791
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Entity Type | Individual
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Provider Name | HEATHER NICOLE UNDERHILL D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 571 SAINT JOSEPHS BLVD FL 2
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City | ELMIRA
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State | NY
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Zip | 14901-3230
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Country | US
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Telephone | 607-271-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 BROADWAY ST
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City | ELMIRA
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State | NY
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Zip | 14904-2502
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Country | US
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Telephone | 607-734-7982
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 284889
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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