Individual
LAURA J HEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2620 COMMERCIAL WAY, SUITE 051, ROCK SPRINGS, WY 82901-4755
(307) 382-2080
(307) 382-5099
Mailing address
2620 COMMERCIAL WAY, SUITE 051, ROCK SPRINGS, WY 82901-4755
(307) 382-2080
(307) 382-5099
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
17189.0261
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118483100
—
WY
01
—
17189.0261
STATE NURSING LICENSE
WY
01
—
260064367
TAX ID
WY
01
—
312190
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/20/2006
Last updated
01/25/2010
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