Healthcare Provider Details

I. General information

NPI: 1215984828
Provider Name (Legal Business Name): LUCILLE HEFFNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-6654
  • Fax: 860-714-8110
Mailing address:
  • Phone: 860-714-6654
  • Fax: 860-714-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000192
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: