Provider Demographics
NPI:1255202941
Name:LAROCK, HEATHER LYNN (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:LAROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1195 COUNTY ROUTE 24
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-3330
Mailing Address - Country:US
Mailing Address - Phone:315-212-7159
Mailing Address - Fax:
Practice Address - Street 1:1195 COUNTY ROUTE 24
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-3330
Practice Address - Country:US
Practice Address - Phone:315-212-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690975364SM0705X, 364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health