Healthcare Provider Details

I. General information

NPI: 1386068971
Provider Name (Legal Business Name): MARY LAURENCE HEBERT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 160/163 BLDG KA2010
KAYENTA AZ
86033-0368
US

IV. Provider business mailing address

1156 BOWMAN CTST100A
MT. PLEASANT SC
29464
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-4000
  • Fax:
Mailing address:
  • Phone: 888-686-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN097404
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: