Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC-002888-L | PA |
NPI | 1255406989 |
---|---|
Provider Name | Dr. Richard Joseph Heithaus |
First Address | Jeannette, PA 15644-0768 |
Second Address | Jeannette, PA 15644-1896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 27/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049974 | (05) | PA |
T72482 | (02) | PA |