Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS018275 | PA |
NPI | 1205195054 |
---|---|
Provider Name | Dr. Andrea Wilson Heller |
First Address | Coudersport, PA 16915-8161 |
Second Address | Coudersport, PA 16915-8161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 29/03/2021 |