Healthcare Provider Details

I. General information

NPI: 1821126053
Provider Name (Legal Business Name): VERNA M HEFFERNAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W SHAW AVE 102
FRESNO CA
93711-3706
US

IV. Provider business mailing address

223 OBSIDIAN WAY
HERCULES CA
94547-1727
US

V. Phone/Fax

Practice location:
  • Phone: 866-268-2411
  • Fax:
Mailing address:
  • Phone: 510-799-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number475853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: