Individual
MS. LAURA HEBERLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, M.S., ATC
Contact information
Practice address
1405 GRANT AVE, WOODLYN, PA 19094-1615
(570) 242-4585
Mailing address
1405 GRANT AVE, WOODLYN, PA 19094-1615
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT003644
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
PROVIDER CODE 22
—
Enumeration date
04/22/2014
Last updated
04/22/2014
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