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NPI Code Detail

MEDICARE: MS. HEATHER RENEE DEMETRIADES CNP

MEDICARE: MS. HEATHER RENEE DEMETRIADES CNP
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
1363LF0000XFamily Nurse PractitionerCOA.15829-NPOH

General Provider Information

NPI Number : 1417362633
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. HEATHER RENEE DEMETRIADES CNP
Provider Business Mailing Address
First Line : 4216 IRELAN ST
Second Line :
City : KETTERING
State : OH
Zip : 45440-1529
Country : US
Telephone Number : 937-296-0384
Fax Number :
Provider Business Practice Location Address
First Line : 5981 FAR HILLS AVE
Second Line :
City : DAYTON
State : OH
Zip : 45429-2211
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2014
Last Update Date : 06/26/2014

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