Individual
BETH LAUREN HEANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
601 ELMWOOD AVE BOX PSYCH, ROCHESTER, NY 14642-0001
(585) 275-6070
(585) 276-0067
Mailing address
601 ELMWOOD AVE BOX PSYCH, ROCHESTER, NY 14642-0001
(585) 275-6070
(585) 276-0067
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209012405
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
402869
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209012405
LICENSE NUMBER
IL
05
—
370966854006
—
IL
05
—
370966854023
—
IL
Enumeration date
07/02/2013
Last updated
07/03/2023
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