MEDICARE: ELIZABETH HEAPHY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	702646	NY
2	163W00000X	Registered Nurse	RN2322004	MA

General Provider Information

NPI Number	:	1235961251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HEAPHY RN

Provider Business Mailing Address
First Line	:	37 ASHDOWN RD
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-2314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 THOMAS ISLAND RD
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-3033
Country	:	US
Telephone Number	:	518-466-0880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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