Basic Information
| Provider Information | |||||||||
| NPI: | 1619610334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIDELBACH | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 ALPINE CIR | ||||||||
| Address2: | |||||||||
| City: | ROSTRAVER TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150126821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245544249 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 BROOKS LN STE 180 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124693600 | ||||||||
| FaxNumber: | 4124693630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2022 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP025232 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.