Provider Demographics
NPI:1366772428
Name:GARRETT, HEATHER S (VN243191)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:S
Last Name:GARRETT
Suffix:
Gender:F
Credentials:VN243191
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CLEVELAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4282
Mailing Address - Country:US
Mailing Address - Phone:707-576-0818
Mailing Address - Fax:707-576-7845
Practice Address - Street 1:1901 CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4282
Practice Address - Country:US
Practice Address - Phone:707-576-0818
Practice Address - Fax:707-576-7845
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN243191164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse