Provider Demographics
NPI:1023353208
Name:GADDESS, HEIDI RAE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:RAE
Last Name:GADDESS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 W SPRING ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1655
Mailing Address - Country:US
Mailing Address - Phone:814-827-9675
Mailing Address - Fax:814-827-0216
Practice Address - Street 1:339 W SPRING ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1655
Practice Address - Country:US
Practice Address - Phone:814-827-9675
Practice Address - Fax:814-827-0216
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily