Healthcare Provider Details

I. General information

NPI: 1558889113
Provider Name (Legal Business Name): NANCY DIANE HEJNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S CALUMET RD STE 3
CHESTERTON IN
46304-3286
US

IV. Provider business mailing address

724 MORGAN ST
GARY IN
46403-2171
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-9675
  • Fax: 219-983-9681
Mailing address:
  • Phone: 708-772-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: