Provider Demographics
NPI:1447021076
Name:JOHN, HEATHER L (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:JOHN
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:GERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2458 STETZER RD
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2066
Mailing Address - Country:US
Mailing Address - Phone:419-562-2000
Mailing Address - Fax:
Practice Address - Street 1:2458 STETZER RD
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2066
Practice Address - Country:US
Practice Address - Phone:419-562-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.520706163W00000X
OHAPRN.CNP.0037096363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse