Provider Demographics
NPI:1144716333
Name:HEIMERL, MEGAN KATHERINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHERINE
Last Name:HEIMERL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:K
Other - Last Name:VAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-630-1000
Practice Address - Fax:716-630-1348
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily