Provider Demographics
NPI:1174986418
Name:REYES, HEATHER (LPN)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:FURBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6432 N KIRKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KIRKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13082-9313
Mailing Address - Country:US
Mailing Address - Phone:315-708-7594
Mailing Address - Fax:
Practice Address - Street 1:6432 N KIRKVILLE RD
Practice Address - Street 2:
Practice Address - City:KIRKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13082-9313
Practice Address - Country:US
Practice Address - Phone:315-708-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10-323344164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse