MEDICARE: MRS. HEATHER LYNN BAZAN R.N.

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	163WS0200X	School Registered Nurse	493790-1	NY

General Provider Information

NPI Number	:	1598194623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER LYNN BAZAN R.N.

Provider Business Mailing Address
First Line	:	2755 STATE HIGHWAY 67
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3747
Country	:	US
Telephone Number	:	518-736-4681
Fax Number	:	518-725-6754

Provider Business Practice Location Address
First Line	:	2755 STATE HIGHWAY 67
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095
Country	:	US
Telephone Number	:	518-661-6779
Fax Number	:

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

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	12/05/2025

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