Individual
STEPHANIE HEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
390 EAST FAIRMOUNT AVE, LAKEWOOD, NY 14750
(716) 526-0156
Mailing address
390 EAST FAIRMOUNT, LAKEWOOD, NY 14750
(716) 526-0156
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
11/17/2014
Last updated
11/09/2021
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