Provider Demographics
NPI:1578358685
Name:CARRERA, HEATHER ASHLEY (DCN, MS, CNS, CDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ASHLEY
Last Name:CARRERA
Suffix:
Gender:
Credentials:DCN, MS, CNS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 YARROW HL
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9402
Mailing Address - Country:US
Mailing Address - Phone:585-773-0766
Mailing Address - Fax:
Practice Address - Street 1:2 YARROW HL
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9402
Practice Address - Country:US
Practice Address - Phone:585-773-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010810133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist