Provider Demographics
NPI:1922984269
Name:RICH, HEIDI (REGISTERED NURSE RN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:REGISTERED NURSE RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1461
Mailing Address - Country:US
Mailing Address - Phone:814-464-5360
Mailing Address - Fax:
Practice Address - Street 1:201 OLD MAIN
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-1503
Practice Address - Country:US
Practice Address - Phone:814-898-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN602580163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice